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Lopes N, Tavares D, Pegado E, Raposo H, Rodrigues C. Medication use for the management of professional performance: between invisibility and social normalisation. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2024:1-18. [PMID: 38919993 DOI: 10.1080/14461242.2024.2362174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 05/27/2024] [Indexed: 06/27/2024]
Abstract
This article aims to explore pharmaceuticalisation processes in professional work contexts. The approach focuses on identifying patterns of medicine and dietary supplement use for managing work performance, and on discussing the relationship between these consumption practices and work-related pressure factors. This analysis adapts the notions of 'normalisation' to understand the extent of cultural acceptability of these practices, and the notion of 'differentiated normalisation' to capture the tension between the trend towards normalisation of such consumption and its partial social (in)visibility within work settings. Empirical support for this analysis is based on a sociological study conducted in Portugal on professions under high performance pressures. The study involved three professional groups - nurses, journalists and police officers. A mixed methods approach was used, including focus groups, questionnaires and semi-structured interviews. Overall, the results show a trend towards the use of medicines and supplements for performance management, which reveals itself as a cultural response to work-related social pressures. Such consumption coexists with irregular patterns of either occasional or long-term use, as well as heterogeneous processes of 'normalisation' and 'hidden' consumption. Conclusions point to a social interconnection between the intensification of work pressures and the pharmaceuticalisation of work performance.
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Affiliation(s)
- Noémia Lopes
- Iscte - Instituto Universitário de Lisboa, CIES-Iscte, Lisboa, Portugal
- Egas Moniz School of Health & Science, CiiEM-Egas Moniz Interdisciplinary Research Center, Caparica, Portugal
| | - David Tavares
- Iscte - Instituto Universitário de Lisboa, CIES-Iscte, Lisboa, Portugal
- ESTeSL - Escola Superior de Tecnologia da Saúde de Lisboa, Lisboa, Portugal
| | - Elsa Pegado
- Iscte - Instituto Universitário de Lisboa, CIES-Iscte, Lisboa, Portugal
| | - Hélder Raposo
- Iscte - Instituto Universitário de Lisboa, CIES-Iscte, Lisboa, Portugal
- ESTeSL - Escola Superior de Tecnologia da Saúde de Lisboa, Lisboa, Portugal
| | - Carla Rodrigues
- Iscte - Instituto Universitário de Lisboa, CIES-Iscte, Lisboa, Portugal
- Department of Sociology, University of Amsterdam, Amsterdam, The Netherlands
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Borozdina E, Zvonareva O. Medical professionals' agency and pharmaceuticalization: Physician-industry relations in Russia. Health (London) 2024; 28:108-125. [PMID: 35913030 PMCID: PMC10714710 DOI: 10.1177/13634593221116508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the contemporary world pharmaceuticals have become a go-to answer to a growing number of questions. This process of pharmaceuticalization gives rise to a concern with the increasing influence of the pharmaceutical industry on physicians' decision-making. Critics suggest that companies' for-profit-interests might compromise the integrity of medical practice. This article employs qualitative research methodology to explore how Russian physicians deal with the industry's efforts to expand and shape the use of pharmaceuticals. By bridging perspectives of social studies of science and sociology of professions, we offer a contextualized account of physicians' daily practices and interpretations related to pharmaceuticalization. The findings question conventional assumptions of physician-industry relations and allow to delineate a new form of medical professionalism that emerges in the context of pharmaceuticalization and cannot be reduced to either "resisting" industry marketing activities or "giving in" to them and thus corrupting biomedical expertise. Instead, the ways in which physicians navigate abundant sources of knowledge and use industry resources to overcome constraints of their organizational environment attest to mundane forms of agency exercised by physicians in their relations with industry.
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Affiliation(s)
- Ekaterina Borozdina
- European University at St. Petersburg, The Russian Federation
- Siberian State Medical University, The Russian Federation
| | - Olga Zvonareva
- Maastricht University, The Netherlands
- Siberian State Medical University, The Russian Federation
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Sud A, Chiu K, Friedman J, Dupouy J. Buprenorphine deregulation as an opioid crisis policy response - A comparative analysis between France and the United States. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 120:104161. [PMID: 37619440 DOI: 10.1016/j.drugpo.2023.104161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 07/22/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND In passing the Maintstreaming Addiction Treatment Act, the United States has abolished its federal X waiver, considered a major barrier to the wider buprenorphine prescribing needed to respond to opioid-related harms. Advocates for this policy have drawn on the French response of deregulating buprenorphine prescribing to address increasing overdose mortality around the turn of the millennium. So far, such policy advocacy has incompletely accounted for contextual and health system differences between the two countries. METHODS Using the health system dynamics framework, this analysis compares France from 1995 to 2003 (the relevant period of buprenorphine reform) to the US from 2018 until today (the comparison period to explore potential impacts of reform). We used it to guide examination of a) contextual issues relating to opioid use epidemiology and b) health system factors including prescriber supply, sector organization, and insurance coverage for primary care to draw relevant policy learning for the contemporary US. RESULTS We identified that the US had a 22.5-fold higher mortality rate and a 2.3-fold higher opioid use disorder (OUD) rate compared to France, despite having rates of prescribed buprenorphine per-capita higher than, and per-person with OUD comparable to, than that of France. These wide gulfs between the scales and nature of the problems between France and the US suggest that relaxing restrictions on buprenorphine prescribing through abolishing the X waiver will be insufficient for achieving hoped-for reductions in overdose mortality. CONCLUSION Health system strengthening with a focus on improvements in primary care prescriber supply, coverage, and coordination are likely higher yield policy complements to relaxing buprenorphine regulation. Such an approach would better prepare the US to adapt to ongoing dynamics and uncertainties in the opioid crisis and to optimize the already relatively high levels of buprenorphine prescribing.
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Affiliation(s)
- Abhimanyu Sud
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada; Humber River Hospital, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
| | - Kellia Chiu
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Joseph Friedman
- Center for Social Medicine and Humanities, University of California, Los Angeles, United States
| | - Julie Dupouy
- University Department of General Medicine, University of Toulouse, Faculty of Medicine, Toulouse, France; Inserm UMR1295, University of Toulouse III, Faculty of Medicine, Toulouse, France
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Dertadian GC. Is non-medical use normal? Normalisation, medicalisation and pharmaceutical consumption. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 119:104123. [PMID: 37454607 DOI: 10.1016/j.drugpo.2023.104123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/01/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
The theory of the normalisation of youth drug use in advanced capitalist societies has had an enduring legacy in contemporary drug scholarship. While the literature on the normalisation of 'illicit' drugs is well developed, less has been written about application of the theory to emerging discourse of pharmaceutical 'abuse', and how this might necessitate different thinking around what can be considered normal consumption. Pharmaceuticals are not directly associated with criminality, and their use does not traditionally attract stigma. In fact, social science scholarship has illustrated how many substances deemed illicit are normalised in the context of an ever-growing set of medical treatments. This paper explores the assumptions about legality, sociality and pleasure which sit behind the drug normalisation thesis, by reflecting on the relevance of drug normalisation in relation to pharmaceuticals, as well as examining scholarship on the medicalisation of society and qualitative research on non-medical use to illustrate the parallel processes of normalisation that apply to pharmaceuticals. The paper argues that questions of normalisation in relation to pharmaceutical use require a deeper engagement with the normative expectations we attach to pleasure, consumption and medicine, and the way this is structured by proximity to medical authority, whiteness and middle-classness.
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Colman L, Delaruelle K, Bracke P, Ceuterick M. Trends in the use of benzodiazepine receptor agonists among working-age adults in Belgium from 2004 to 2018. Front Public Health 2023; 11:1191151. [PMID: 37397739 PMCID: PMC10311493 DOI: 10.3389/fpubh.2023.1191151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction The use of psychotropics, such as benzodiazepine receptor agonists (BzRAs), among working-age adults in Belgium has shown educational differences. However, it is unclear how work status plays a role in this relationship. Therefore, this research aims to investigate whether work status explains observed educational differences in BzRA use. In addition, considering medicalisation processes, where non-medical factors, such as work status, are increasingly associated with medical mental health care-seeking behavior, this research also aims to investigate whether work status explains observed educational differences in BzRA use, regardless of mental health status. Methods Data are obtained from the Belgian Health Interview Survey (BHIS). Four successive waves are covered: 2004, 2008, 2013, and 2018. The weighted data represent a sample of 18,547 Belgian respondents aged 18 to 65 years old. Poisson regression models are used to analyze the research aims. Time evolutions are plotted using marginal means postestimation. Results The average use of BzRAs shows a slight decline over the waves studied (2004 = 5.99, 2008 = 5.88, 2013 = 5.33, 2018 = 4.31). Educational and work status differences in BzRA use are observed, regardless of mental health status. Individuals with longer education report lower use compared to individuals with shorter education, and individuals who are unemployed, (pre-)retired, or sick or disabled report higher use compared to employed individuals. Furthermore, work status acts as a mediator, partially explaining educational differences in BzRA use, regardless of mental health status. Discussion Work-related uncertainty leads to increased prescribing and medication use, regardless of mental health. Medicalisation and pharmaceuticalisation processes detach social problems from their social roots and treat them as personal failures. The marginalization of the social roots of unemployment, sick leave and involuntary (pre-)retirement has led to a personalization of responsibility. Negative feelings arising from such work statuses may cause isolated, non-specific symptoms for which medical treatment is sought.
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Gibbs N. #Sponseredathlete: the marketing of image and performance enhancing drugs on Facebook and Instagram. TRENDS IN ORGANIZED CRIME 2023:1-40. [PMID: 37363752 PMCID: PMC10043544 DOI: 10.1007/s12117-023-09491-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 06/28/2023]
Abstract
This article sets out to investigate the marketing of image and performance enhancing drugs (IPEDs) on the social media platforms Facebook and Instagram. Drawing upon a 'connective' ethnographic exploration of IPED use and supply, the paper first outlines a supplier typology on these platforms, before shedding light on the marketing strategies employed by sellers in order to overcome the inherent distrust of online sales and build a trustworthy brand. Techniques identified include athlete sponsorship, the sharing of bodybuilding fitspiration content, self-objectification, posting images showcasing transformation photos and customer feedback, and seasonal sales and promotions. Analysis encompasses the centrality of product branding, the overlaps between licit and illicit market advertising strategies, and the affordances of the platforms under study. Finally, conclusions relating to the implications of these findings to scholarship, policy, and regulation are offered.
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Affiliation(s)
- Nick Gibbs
- Northumbria University, Lipman 032, 2 Sandyford Rd, Newcastle upon Tyne, NE1 8SB UK
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Diasio N. Illegitimate bodies? Turner syndrome and the silent interplay of age, gender, and generational positions. FRONTIERS IN SOCIOLOGY 2023; 8:1084707. [PMID: 36968511 PMCID: PMC10030844 DOI: 10.3389/fsoc.2023.1084707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/31/2023] [Indexed: 06/18/2023]
Abstract
This paper focuses on the strength of social norms that define the right development of the body in time. It also analyzes how the social positions of age, gender and generation intertwine in the definition of such a legitimate body. The starting point is anthropological research carried out in France between 2018 and 2020 among girls and women affected by Turner syndrome, a rare genetic condition causing small stature, ovarian insufficiency, a delay or absence of puberty, and infertility. We first explore how measuring the body has become central in the social construction of the concept of age-appropriateness. We then present four women' narratives, which express various forms of desynchronization: the gap between physical appearance, chronological age and age status; the cleft between the physical development induced by hormone therapy and being in a particular stage in life; the difference between chronological and reproductive age; and lastly, the trouble in a generational position related to infertility. For women suffering from this genetic condition, the gap between bodies, time and social statuses associated with age, gender and generation, may engender a feeling of "being out of place." The alignment of body and time is then one of the bastions of essentialization and naturalization. Finally, we stress the complex interplay of bodily and social markers of age and gender, and their role in social relations as both a resource and a constraint. Thus, while the syndrome may cause distress and sometimes a lack of legitimacy, it also leads to a critical re-examination of hegemonic models of womanhood and their intersection with age positions.
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Martin PA. The challenge of institutionalised complicity: Researching the pharmaceutical industry in the era of impact and engagement. SOCIOLOGY OF HEALTH & ILLNESS 2022; 44 Suppl 1:158-178. [PMID: 36217290 PMCID: PMC10092677 DOI: 10.1111/1467-9566.13536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/01/2022] [Indexed: 06/16/2023]
Abstract
The pharmaceutical industry plays a central role in the production of the drugs we use to treat most illnesses. It is immensely powerful and has received sustained attention from sociologists of health and illness, who have provided a critique of its influence and sometimes unethical behaviour. However, in recent years, funders are increasingly expecting researchers to engage and collaborate with stakeholders, including industry. This raises important questions about the institutionalisation of complicity and the different forms this might take. This article asks: How can sociologists engage with the pharmaceutical industry in a positive and constructive manner, whilst remaining independent, principled and critical? It will draw on my experience of establishing a major project on high-priced drugs for rare diseases and the literature on collaboration, stakeholder engagement and responsible research to propose a methodological framework to address this challenge. This is based on six PRIMES: (normative) Principles, Reflection and Independence, (field) Mapping, (careful) Engagement and Strategic intervention that have broad applications to many other areas of contemporary social science research.
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Affiliation(s)
- Paul A. Martin
- iHuman InstituteUniversity of SheffieldSheffieldUK
- Department of Sociological StudiesUniversity of SheffieldSheffieldUK
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Bombak AE, Adams L, Thille P. Drivers of medicalization in the Canadian Adult Obesity Clinical Practice Guidelines. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2022; 113:743-748. [PMID: 35838981 PMCID: PMC9481752 DOI: 10.17269/s41997-022-00662-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 06/13/2022] [Indexed: 06/15/2023]
Abstract
The new Canadian Adult Obesity Clinical Practice Guidelines frame higher body weight as a chronic, relapsing disease requiring comprehensive medical treatment pathways. In this commentary, we will demonstrate how a process called pharmaceuticalization is informing the new guidelines. We join those questioning the normalization of industry and medical collaboration and interrogate whether the new guidelines meaningfully address stigma.
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Affiliation(s)
- Andrea E Bombak
- Department of Sociology, University of New Brunswick, 3 Bailey Drive, P.O. Box 4400, Fredericton, New Brunswick, E3B 5A3, Canada.
| | - Louise Adams
- Flourish Kirribilli, 13/1 Broughton St, Kirribilli, NSW, 2061, Australia
| | - Patricia Thille
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Room R131 - 771 McDermot Ave., Winnipeg, MB, R3E 0T6, Canada
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Wattanapisit A, Sottiyotin T, Thongruch J, Wattanapisit S, Yongpraderm S, Kowaseattapon P. Self-Care Practices of Patients with Non-Communicable Diseases during the COVID-19 Pandemic: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9727. [PMID: 35955084 PMCID: PMC9368016 DOI: 10.3390/ijerph19159727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/05/2022] [Accepted: 08/06/2022] [Indexed: 06/15/2023]
Abstract
Individuals with chronic non-communicable diseases (NCDs) have a higher risk of morbidity and mortality. This study explores the lived experience of patients with NCDs during the COVID-19 pandemic and the impact of COVID-19 on their self-care. An interpretive phenomenological analysis approach was used that involved in-depth interviews with patients who received medical services from a family medicine clinic, along with caregivers who responded on their behalf. An inductive thematic approach was utilized to analyze the data. Interview respondents included 17 patients with NCDs and four caregivers. The patients had a mean age of 65.7 ± 11.3 years and were diagnosed with an NCD, a mean of 4.8 ± 1.1 years previously. Self-care practices used during the pandemic were classified as therapeutic or preventive. Patients responded to changes in healthcare services by seeking in-person services for their acute illnesses and accepting remote services for underlying chronic conditions. The COVID-19 pandemic influenced the self-care practices of patients with NCDs. Most patients paid more attention to self-care during this time, while some became more concerned with other aspects of their life.
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Affiliation(s)
- Apichai Wattanapisit
- School of Medicine, Walailak University, Thasala, Nakhon Si Thammarat 80160, Thailand
- Family Medicine Clinic, Walailak University Hospital, Thasala, Nakhon Si Thammarat 80160, Thailand
| | - Tida Sottiyotin
- School of Pharmacy, Walailak University, Thasala, Nakhon Si Thammarat 80160, Thailand
| | - Jaruporn Thongruch
- Family Medicine Clinic, Walailak University Hospital, Thasala, Nakhon Si Thammarat 80160, Thailand
| | | | - Siranee Yongpraderm
- School of Pharmacy, Walailak University, Thasala, Nakhon Si Thammarat 80160, Thailand
| | - Pichawee Kowaseattapon
- Family Medicine Clinic, Walailak University Hospital, Thasala, Nakhon Si Thammarat 80160, Thailand
- School of Pharmacy, Walailak University, Thasala, Nakhon Si Thammarat 80160, Thailand
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Differentiated Primary Healthcare in the Pataxó Indigenous Communities in Bahia, Brazil: Polyphonic Ethnography of Healthcare Practices from an Intercultural Perspective. SOCIAL SCIENCES-BASEL 2022. [DOI: 10.3390/socsci11050189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A lack of culturally appropriate healthcare is a common problem for colonial nations, and this can explain the different patterns of health in indigenous populations worldwide. Our study is the first ethnography realized with the neglected Pataxó indigenous people from the south of the state of Bahia, Brazil, that analyzes the representations and practices of “differentiated” public healthcare. The polysemic conceptualization and polymorphism of the healthcare practices highlight some spontaneous intercultural competences, particularly those of the indigenous professionals, within the hegemony of non-indigenous health knowledge and the lack of awareness of intercultural healthcare. Intercultural training and empowerment still remain a priority.
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Mintz D. Recovery from Childhood Psychiatric Treatment: Addressing the Meaning of Medications. Psychodyn Psychiatry 2022; 50:131-148. [PMID: 35235407 DOI: 10.1521/pdps.2022.50.1.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
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.
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Affiliation(s)
- David Mintz
- Director of Psychiatric Education/Associate Director of Training/Team Leader, Austen Riggs Center
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Greco C, Graber N. Anthropology of new chronicities: illness experiences under the promise of medical innovation as long-term treatment. Anthropol Med 2022; 29:1-13. [PMID: 35331070 DOI: 10.1080/13648470.2022.2041550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
In the introduction to the special issue, Greco and Graber discuss the concept of chronicity and the ways it is used in the contributions to the special issue. Historians have shown that the concept of chronic disease has its origins in policy and has always been fluid and vague; however, the classic literature in sociology and nursing has focused on modelling the evolution of chronic disease rather than on examining the concept itself. In the introduction, chronicity is explored in the ways in which it is transformed by medical innovation. Innovations in biomedicine promise to turn terminal and acute conditions in chronic and to render chronic conditions curable. Even when such promises are not fulfilled, they change the context of the illness and the experiences of patients. In such a context a specific work is required from patients, in terms of adherence to the treatments, but also in terms of pursuing experimental treatments that could make their condition chronic. The introduction offers a critical exploration of the concept of chronicity, highlighting both its fluid definition and the changes linked to medical innovation, and the ways in which it shapes the temporalities and experiences of illness in complex ways that cannot be reduced to simplified schemas and trajectories.
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Affiliation(s)
- Cinzia Greco
- Wellcome Trust Research Fellow, Centre for the History of Science, Technology and Medicine (CHSTM), The University of Manchester, Manchester, UK
| | - Nils Graber
- STS Lab, University of Lausanne Institute of Social Sciences, Lausanne, Switzerland
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Lenssen KG, Bast A, de Boer A. The complexity of proving health effects with data on ‘traditional use’: A critical perspective on supporting botanical health claims. Trends Food Sci Technol 2022. [DOI: 10.1016/j.tifs.2021.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Miller G, Kuch D, Kearnes M. Reimagining Health as a 'Flow on Effect' of Biomedical Innovation: Research Policy as a Site of State Activism. MINERVA 2022; 60:235-256. [PMID: 35068589 PMCID: PMC8765493 DOI: 10.1007/s11024-021-09456-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/13/2021] [Indexed: 06/14/2023]
Abstract
As health care systems have been recast as innovation assets, commercial aims are increasingly prominent within states' health and medical research policies. Despite this, the reformulation of notions of social and of scientific value and of long-standing relations between science and the state that is occurring in research policies remains comparatively unexamined. Addressing this lacuna, this article investigates the articulation of 'actually existing neoliberalism' in research policy by examining a major Australian research policy and funding instrument, the Medical Research Future Fund (MRFF). We identify the MRFF and allied initiatives as a site of state activism: reallocating resources from primary and preventive health care to commercially-oriented biomedical research; privileging commercial objectives in research and casting health as a "flow on effect"; reorganising the publicly funded production of health and medical knowledge; and arrogating for political actors a newly prominent role in research grant assessment and funding allocation. We conclude that rather than the state's assumption of a more activist role in medical research and innovation straightforwardly serving a 'public good', it is a driver of neoliberalisation that erodes commitments to redistributive justice in health care and significantly reconfigures science-state relations in research policy.
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Affiliation(s)
- Georgia Miller
- ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, School of Humanities and Languages, University of New South Wales, UNSW, NSW 2052 Australia
| | - Declan Kuch
- Institute for Culture and Society, Western Sydney University, Penrith, NSW 2751 Australia
| | - Matthew Kearnes
- ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, School of Humanities and Languages, University of New South Wales, UNSW, NSW 2052 Australia
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Brandão ER, Cabral CDS. Vidas precárias: tecnologias de governo e modos de gestão da fecundidade de mulheres “vulneráveis”. HORIZONTES ANTROPOLÓGICOS 2021. [DOI: 10.1590/s0104-71832021000300002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
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”.
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Bäckryd E. The pharmaceuticalisation of life? A fictional case report of insomnia with a thought experiment. PHILOSOPHY, ETHICS, AND HUMANITIES IN MEDICINE 2021; 16:10. [PMID: 34600540 PMCID: PMC8487481 DOI: 10.1186/s13010-021-00109-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/04/2021] [Indexed: 11/10/2022] Open
Abstract
Background The safety of sleeping pills has increased dramatically during the last 100 years, from barbiturates to bensodiazepines to modern day so-called Z-drugs. Methods The circumstances of prescribing sleeping pills in the early 20th century are illustrated by summarizing the main storyline of a novel by Swedish writer Vilhelm Moberg. This is followed by a thought experiment and a theoretical discussion. Results In his 1937 novel Sömnlös (Swedish for sleepless) Vilhelm Moberg portrayed existential and relational distress in relation to insomnia. In a thought experiment, past progresses in sleeping pills safety are projected into the future. Thereby, it is claimed that important issues in the area of philosophy of medicine come to the fore. This leads to a theoretical discussion about broader questions concerning the role of the physician, the goals of medicine (as described by Lennart Nordenfelt), the concept of pharmaceuticalisation (as described notably by sociologist of sleep Simon J. Williams and co-workers), and health enhancement (c.f. Carl Elliott and the alleged wish to be better than well). Conclusion Insomnia is a prism through which important philosophical and sociological questions related to the practice of medicine can be asked.
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Narayanan A, Gill M, Leem C, Li C, Mein Smith F, Shepherd B, Ting S, van Bart K, Green JA, Samaranayaka A, Ergler C, Macmillan A. Students' use of caffeine, alcohol, dietary supplements, and illegal substances for improving academic performance in a New Zealand university. Health Psychol Behav Med 2021; 9:917-932. [PMID: 34712515 PMCID: PMC8547821 DOI: 10.1080/21642850.2021.1990763] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
This study aimed to describe patterns of use and attitudes towards a broad variety of substances for improving academic performance at a New Zealand university. 685 students (from 1800 invited) completed an online questionnaire (38% response rate). They were asked about their lifetime and current substance use for improving academic performance, as well as their reasons for use, attitudes and perceptions of: caffeine, alcohol, dietary supplements, prescription stimulants, other prescription substances, and illicit substances. 80% (95% CI: 76.3, 82.5) reported ever using any substance to help improve academic performance, mainly to stay awake and improve concentration. Caffeine (70%, 95% CI: 66.3, 73.3) and dietary supplements (32%, 95% CI: 28.3, 35.5) were most commonly used. 4% (95% CI: 2.7, 5.9) reported use of prescription stimulants, mostly methylphenidate, and another 4% (95% CI: 2.7, 5.9) reported using illicit substances for improving academic performance. Users of prescription stimulants were more likely than non-users to believe that they were safe, morally acceptable, and that they should be available legally for enhancing academic performance. We close with discussions on broadening the focus of substances for improving academic performance in public health debates. Further qualitative research from small countries is also needed to move towards a place-based approach for clarifying ethical implications, inform policy in universities, and understand how injustices are created through the use of and ability to purchase different substances.
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Affiliation(s)
- Anantha Narayanan
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Malcolm Gill
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Chaey Leem
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Cassandra Li
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | | | - Ben Shepherd
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Selene Ting
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Karin van Bart
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - James A Green
- School of Pharmacy, University of Otago, Dunedin, New Zealand.,School of Allied Health, University of Limerick, Limerick, Ireland.,Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Ari Samaranayaka
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Christina Ergler
- Department of Geography, University of Otago, Dunedin, New Zealand
| | - Alexandra Macmillan
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
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Pilgrim D. Transgender debates and healthcare: A critical realist account. Health (London) 2021; 26:535-553. [PMID: 34608816 DOI: 10.1177/13634593211046840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The meta-theoretical resource of critical realism (CR) is deployed in order to examine transgender and healthcare. CR treads a middle way between positivism and postmodernism, within post-Popperian discussions of the philosophy of natural and social science. It focuses on the conditions of possibility for the emergence of a phenomenon under investigation. In this case, the focus is on the emergence of debates about transgenderism in healthcare. These have been technological (about the prospect of biomedical solutions to personal problems) and ideological, with the enlarged salience of identity politics and our currently unresolved "culture wars." Identity politics have brought a focus on epistemological privilege or "lived experience" and on rights to healthcare being driven by consumer choice. The current contestation and its history are discussed in relation to our four planar social being (nature, relationality, socio-economic structures, and our particular personalities) and future scenarios are rehearsed.
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20
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Hunt LM, Arndt EA, Bell HS, Howard HA. Are Corporations Re-Defining Illness and Health? The Diabetes Epidemic, Goal Numbers, and Blockbuster Drugs. JOURNAL OF BIOETHICAL INQUIRY 2021; 18:477-497. [PMID: 34487285 PMCID: PMC8568684 DOI: 10.1007/s11673-021-10119-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 04/24/2021] [Indexed: 05/15/2023]
Abstract
While pharmaceutical industry involvement in producing, interpreting, and regulating medical knowledge and practice is widely accepted and believed to promote medical innovation, industry-favouring biases may result in prioritizing corporate profit above public health. Using diabetes as our example, we review successive changes over forty years in screening, diagnosis, and treatment guidelines for type 2 diabetes and prediabetes, which have dramatically expanded the population prescribed diabetes drugs, generating a billion-dollar market. We argue that these guideline recommendations have emerged under pervasive industry influence and persisted, despite weak evidence for their health benefits and indications of serious adverse effects associated with many of the drugs they recommend. We consider pharmaceutical industry conflicts of interest in some of the research and publications supporting these revisions, and in related standard-setting committees and oversight panels. We raise concern over the long-term impact of these multifaceted involvements. Rather than accept industry conflicts of interest as normal, needing only to be monitored and managed, we suggest challenging that normalcy, and ask: what are the real costs of tolerating such industry participation? We urge the development of a broader focus to fully understand and curtail the systemic nature of industry's influence over medical knowledge and practice.
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Affiliation(s)
- Linda M Hunt
- Department of Anthropology, Michigan State University, 655 Auditorium Drive, East Lansing, MI, 48824, USA.
| | - Elisabeth A Arndt
- Department of Anthropology, Michigan State University, 655 Auditorium Drive, East Lansing, MI, 48824, USA
- College of Osteopathic Medicine, Michigan State University, 909 Wilson Road West Fee Hall, Room 317, East Lansing, MI, 48824, USA
| | - Hannah S Bell
- Department of Anthropology, Michigan State University, 655 Auditorium Drive, East Lansing, MI, 48824, USA
| | - Heather A Howard
- Department of Anthropology, Michigan State University, 655 Auditorium Drive, East Lansing, MI, 48824, USA
- University of Toronto, Centre for Indigenous Studies, 563 Spadina Avenue, Toronto, ON, M5S 2J7, Canada
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Doblytė S. ‘The almighty pill and the blessed healthcare provider’: medicalisation of mental distress from an Eliasian perspective. SOCIAL THEORY & HEALTH 2021. [DOI: 10.1057/s41285-021-00165-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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22
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Doudenkova V. Médicalisation et autonomie des femmes affectées par le syndrome des ovaires polykystiques. CANADIAN JOURNAL OF BIOETHICS 2021. [DOI: 10.7202/1077630ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Victoria Doudenkova
- Programmes de sciences biomédicales, Faculté de médecine, Université de Montréal, Montréal, Canada
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Douglass T, Calnan M. The Disparate Approaches of General Practitioners to the Pharmaceuticalisation of Cardiovascular Disease Prevention. FRONTIERS IN SOCIOLOGY 2021; 6:650997. [PMID: 34095288 PMCID: PMC8176921 DOI: 10.3389/fsoc.2021.650997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 05/06/2021] [Indexed: 06/12/2023]
Abstract
In the context of current clinical practice guidance, this paper will analyse the role of GPs in decision-making about the primary prevention of cardiovascular disease (CVD) using the concept of pharmaceuticalisation. Drawing on thematic analysis of semi-structured interviews with 20 GPs, the paper argues that the way GPs approach CVD pharmaceuticalisation is shaped by their understandings of and use of guidelines (and the knowledge they embody), existing treatment perspectives and the moral qualities of preventative treatment, and professional evaluations of 'relevant' information. The analysis indicates that there exist disparate and distinct approaches to and understandings of CVD pharmaceuticalisation amongst GPs. Depending on how knowledge, treatment perspectives and values variously combine, GPs sit somewhere on a spectrum of how pharmaceuticalised they are in terms of the approaches to and understandings of the prevention of CVD.
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Affiliation(s)
- Tom Douglass
- Department of Communication and Media, Ulster University, Newtownabbey, United Kingdom
| | - Michael Calnan
- School of Social Policy, Sociology and Social Policy, University of Kent, Canterbury, United Kingdom
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Is there evidence for the racialization of pharmaceutical regulation? Systematic comparison of new drugs approved over five years in the USA and the EU. Soc Sci Med 2021; 280:114049. [PMID: 34044186 DOI: 10.1016/j.socscimed.2021.114049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/02/2021] [Accepted: 05/17/2021] [Indexed: 11/22/2022]
Abstract
Recent decades have seen much interest in racial and ethnic differences in drug response. The most emblematic example is the heart drug BiDil, approved by the US Food and Drug Administration in 2005 for "self-identified blacks." Previous social science research has explored this "racialization of pharmaceutical regulation" in the USA, and discussed its implications for the "pharmaceuticalization of race" in terms of reinforcing certain taxonomic schemes and conceptualizations. Yet, little is known about the racialization of pharmaceutical regulation in the USA after BiDil, and how it compares with the situation in the EU, where political and regulatory commitment to race and ethnicity in pharmaceutical medicine is weak. We have addressed these gaps by investigating 397 product labels of all novel drugs approved in the USA (n = 213) and the EU (n = 184) between 2014 and 2018. Our analysis considered statements in labeling and the racial/ethnic categories used. Overall, it revealed that many labels report race/ethnicity demographics and subgroup analyses, but that there are important differences between the USA and the EU. Significantly more US labels specified race/ethnicity demographics, as expected given the USA's greater commitment to race and ethnicity in pharmaceutical medicine. Moreover, we found evidence that reporting of race/ethnicity demographics in EU labels was driven, in part, by statements in US labels, suggesting the spillover of US regulatory standards to the EU. Unexpectedly, significantly more EU labels reported differences in drug response, although no drug was restricted to a racial/ethnic population in a manner similar to BiDil. Our analysis also noted variability and inconsistency in the racial/ethnic taxonomy used in labels. We discuss implications for the racialization of pharmaceutical regulation and the pharmaceuticalization of race in the USA and EU.
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25
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Kaczmarek E. Promoting diseases to promote drugs: The role of the pharmaceutical industry in fostering good and bad medicalization. Br J Clin Pharmacol 2021; 88:34-39. [PMID: 33769584 DOI: 10.1111/bcp.14835] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/15/2021] [Indexed: 12/30/2022] Open
Abstract
The pharmaceutical industry and drugs advertisements are sometimes accused of "creating diseases". This article assesses and describes the role of that industry in fostering medicalization. First, the notions of medicalization and pharmaceuticalization are defined. Then, the problem of distinguishing between harmful overmedicalization and well-founded medicalization is presented. Next, the phenomenon of disease mongering is explained and illustrated by the case analysis of medicalizing pain and suffering in three contexts: (1) the general idea of medicalizing physical pain, (2) the medicalization of grief and (3) disease mongering of pseudoaddiction-a condition promoted in order to increase the demand for opioid pain relievers.
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26
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Kerr A, Chekar CK, Swallow J, Ross E, Cunningham-Burley S. Accessing targeted therapies for cancer: self and collective advocacy alongside and beyond mainstream cancer charities. NEW GENETICS AND SOCIETY 2021; 40:112-131. [PMID: 34720747 PMCID: PMC8547735 DOI: 10.1080/14636778.2020.1868986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 12/15/2020] [Indexed: 06/13/2023]
Abstract
As precision oncology has evolved, patients and their families have become more involved in efforts to access these treatments via fundraising and campaigning that take place outside of the larger cancer charities. In this paper, we explore the solidarities, networks, and emotional work of the UK-based access advocates, drawing on the stories of nine advocates, which included interviews and content analyses of their social media posts and coverage of their case in news, commentary, and fundraising websites. We consider the emotional and knowledge work of building networks that spanned consumerist and activist agendas, forged individual and collective goals, and orientations toward the public, private, and third sectors as part of securing support and access. Through these various practices, the actors we have studied cultivated personal advantage and solidarities with other patients and advocates, and in so doing engaged in self and collective advocacy alongside and beyond mainstream cancer charities.
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Affiliation(s)
| | - Choon Key Chekar
- Faculty of Health and Medicine, Lancaster University, LancasterUK
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27
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Armstrong N. Overdiagnosis and overtreatment: a sociological perspective on tackling a contemporary healthcare issue. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:58-64. [PMID: 32964516 DOI: 10.1111/1467-9566.13186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 08/07/2020] [Accepted: 08/11/2020] [Indexed: 06/11/2023]
Abstract
Overdiagnosis and overtreatment are increasingly discussed as a significant problem in contemporary healthcare but are yet to receive any significant sociological attention, over and above that which is arguably transferable from the medicalisation literature. Overdiagnosis and overtreatment are often constructed as problems best addressed by educating patients and clinicians, and improving the relationships between them. The emergence of tools seeking to support decision-making and to facilitate patients' asking questions about whether interventions are really necessary supports this conceptualisation. This article questions whether significant traction on overdiagnosis and overtreatment is possible through these means alone, arguing that even when professionals and patients may wish to do less rather than more, the system within which care is delivered and received can make this challenging to achieve. Drawing on Scott's (Sociology, 2018, 52, 3) 'sociology of nothing', the article demonstrates that a sociological perspective on overdiagnosis and overtreatment recasts them as issues that must be understood as a consequence of the organisational, financial and cultural attributes of the system, not just individual interactions, and advances a research agenda for the area.
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Affiliation(s)
- Natalie Armstrong
- Social Science Applied to Health Improvement Research (SAPPHIRE) Group, Department of Health Sciences, University of Leicester, Leicester, UK
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28
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Flynn MB. Global capitalism as a societal determinant of health: A conceptual framework. Soc Sci Med 2020; 268:113530. [PMID: 33288355 DOI: 10.1016/j.socscimed.2020.113530] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/03/2020] [Accepted: 11/12/2020] [Indexed: 01/24/2023]
Abstract
Recent scholarship has sought to distinguish between the deeper societal factors that shape the more proximate social determinants of health. One of these socio-structural institutions is global capitalism. While critical scholarship has advanced our understanding of the relationships between capitalist globalization and health, more work is needed to understand the transnational economic, political, and cultural practices that affect various global health issues. This paper argues that the theory of global capitalism provides an important, critical perspective for understanding different phenomena associated with global health. The theory's key concepts of transnational corporations, financialization, consumerism, transnational social classes, and transnational state comprise the conceptual framework. When applied to various global health topics, the theory advances our understanding of the health-related institutional structures of today's global economy, provides a holistic view that integrates various strands of health research, highlights various forms of health activism, and offers new questions for addressing persistent health injustice across the world.
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Affiliation(s)
- Matthew B Flynn
- Georgia Southern University, PO Box 8051, Statesboro, GA 30460, USA.
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Giordani RCF, Hoffmann-Horochovski MT. Body care and health obligation: hexis and power in modernity. CIENCIA & SAUDE COLETIVA 2020; 25:4361-4368. [PMID: 33175045 DOI: 10.1590/1413-812320202511.06062019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 04/08/2019] [Indexed: 11/22/2022] Open
Abstract
The aim of this essay is to provide a brief reflection on the contemporary ethics imposed on the body, which points to a growing responsibility and obligation of the individual regarding healthy and correct ways of living. The central object of analysis is the body constitution in modernity, in a space of technical intervention, problematizing contemporary forms of body care, such as diets and physical exercises, which express taxonomies that come from the matrix of meanings in modernity.
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Affiliation(s)
- Rubia Carla Formighieri Giordani
- Departamento de Nutrição, Universidade Federal do Paraná (UFPR). R. Pref. Lothario Meissner 632, Jardim Botânico. 80210-170 Curitiba PR Brasil.
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Looking for the "Little Things": A Multi-Disciplinary Approach to Medicines Monitoring for Older People Using the ADRe Resource. Geriatrics (Basel) 2020; 5:geriatrics5040079. [PMID: 33086499 PMCID: PMC7709700 DOI: 10.3390/geriatrics5040079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 01/29/2023] Open
Abstract
Advances in medicines have increased the effectiveness of treatments and the social and cultural authority of doctors. However, as prescribing has become the dominant modality of treatment, the “pharmaceuticalization” of medical practice has often resulted in treatment “at a distance”, with doctors having limited contact with patients. Older and poorer people, who are socially distanced from medical prescribers, suffer more adverse drug reactions (ADRs) than the general population. A team approach to checking patients systematically for ADRs, as detailed in manufacturers’ literature, can minimise medication errors, but regular review is rare. This paper explains the benefits of medicines monitoring to protect older patients from iatrogenic harm, such as over-sedation, falls, or drug-induced Parkinsonism. We show how multidisciplinary initiatives to optimise prescribing can be supported by using a recognised resource—the adverse drug reaction profile (ADRe). The profile identifies and documents patients’ signs and symptoms of putative ADRs. Better monitoring allows professionals to adjust prescribing and respond to identified problems with agility. Implementation of systematic monitoring will require changes to the regulatory regime and better inter-professional cooperation. Providing carers, nurses and pharmacists with a structured system to monitor patients would democratise relevant medical knowledge and help address ageism and the socio-economic health divide.
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Byrne P, O'Donovan Ó, Smith SM, Cullinan J. A qualitative exploration of the prescribing and use of statins in asymptomatic people in Ireland: A case of medicalisation, biomedicalisation and pharmaceuticalisation. Health (London) 2020; 25:630-648. [PMID: 32715773 DOI: 10.1177/1363459320946067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There has been a notable increase in the use of statins in people without cardiovascular disease but who may be at risk in the future. The majority of statin users now fall into this category but little research has focused exclusively on this group. Debate has ensued regarding medicating asymptomatic people, and processes described variously as medicalisation, biomedicalisation and pharmaceuticalisation are used to explain how this happens. These overlapping and interrelated processes require issues to be 'problemised' as medical problems requiring medical solutions given the prevailing understandings of health, risk and disease. However, current understandings of risk and disease are not simply the result of technological and scientific advances, they are also socially constructed. We interviewed members of the public, GPs and others, and found that rather than high cholesterol being seen as one of several risk factors that contributes to heart disease, it tended to be promoted simplistically to the status of a disease needing treatment of itself. Statins were justified by those taking them as different to 'unnecessary medicines'. However, some participants demonstrated resistance to statins, worried about over-medicalisation and deviated from accepted practices, indicating a complex 'muddling through' in the face of uncertainty.
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Affiliation(s)
- Paula Byrne
- J.E. Cairnes School of Business and Economics, National University of Ireland Galway, Ireland
| | - Órla O'Donovan
- School of Applied Social Studies, University College Cork, Ireland
| | - Susan M Smith
- HRB Centre for Primary Care Research and Department of General Practice, Royal College of Surgeons in Ireland, Ireland
| | - John Cullinan
- J.E. Cairnes School of Business and Economics, National University of Ireland Galway, Ireland
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Pande MNR, Amarante PDDC, Baptista TWDF. [This elusive unknown quantity: reflections on the prescription of psychotropic drugs in early childhood]. CIENCIA & SAUDE COLETIVA 2020; 25:2305-2314. [PMID: 32520275 DOI: 10.1590/1413-81232020256.12862018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 09/25/2018] [Indexed: 11/22/2022] Open
Abstract
The scope of this article is to study aspects related to prescription habits and the use of psychoactive drugs in early childhood. It takes as a starting point the bibliographical survey carried out on the BVS and Scielo databases on epidemiological and clinical research in Brazil regarding the use of psychotropic drugs in children under six years of age. Based on international literature, it highlights the increase in the number of children diagnosed with mental and behavioral disorders, as well as the respective prescription of psychotropic drugs. It discusses the predominantly off-label character of psychoactive drugs for children under six years of age, the heterogeneous use of prescriptions and polypharmacology, pointing to an ethical paradox regarding clinical research in this age group. It concludes that the use of psychotropic drugs in early childhood is as yet not well known in Brazil, and epidemiological studies are urgently needed in this area.
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Affiliation(s)
- Mariana Nogueira Rangel Pande
- Laboratório Estudos e Pesquisas em Saúde Mental e Atenção Psicossocial, Escola Nacional de Saúde Pública Sérgio Arouca (ENSP), Fundação Oswaldo Cruz (Fiocruz). Av. Brasil 4036, Manguinhos. 21040-361, Rio de Janeiro, RJ, Brasil.
| | - Paulo Duarte de Carvalho Amarante
- Laboratório Estudos e Pesquisas em Saúde Mental e Atenção Psicossocial, Escola Nacional de Saúde Pública Sérgio Arouca (ENSP), Fundação Oswaldo Cruz (Fiocruz). Av. Brasil 4036, Manguinhos. 21040-361, Rio de Janeiro, RJ, Brasil.
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Zarhin D. The trajectory of "medical cannabis" in Israel: Driving medicalization in different directions. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 82:102809. [PMID: 32516686 DOI: 10.1016/j.drugpo.2020.102809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/16/2020] [Accepted: 05/25/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Although researchers, laypersons and policymakers have been debating about the "medicalization of cannabis" for years, few have attempted to unpack this phrase and clarify what it actually means. The present qualitative research addresses this issue by tracing the trajectory of "medical cannabis" (MC) in Israel. METHODS This article draws on multiple sources, including in-depth interviews, parliamentary protocols, conference observations, policy documents, and media coverage. RESULTS The analysis shows that while patients, growers, and certain physicians advocated for a more inclusive type of cannabis medicalization, other physicians and sick funds strove to curtail this medicalization; for its part, the Ministry of Health (MoH) attempted to find a pathway that would bridge their conflicting standpoints. In the first phase of medicalization patients' and regulators' trajectories coincided; however, they diverged in the second phase as regulators sought to transform MC into a standardized medication in line with the biomedical model. Patients and physicians criticized the new policy reform and highlighted some of its negative effects on patient care. The trajectories of patients and regulators then intersected in a way that led to some alterations in the MC trajectory. CONCLUSION This study enhances our understanding of how MC was, and is still being, incorporated into medicine in Israel. The study illuminates the plurality of meanings that have been assigned to the concept of medicalization and the contingent nature of MC. Additionally, this study sheds light on the under-investigated role of regulators as drivers of the medicalization of "solutions," and it shows how different engines of medicalization may drive the process in diverging directions.
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Affiliation(s)
- Dana Zarhin
- Department of Sociology, Faculty of Social Sciences, University of Haifa, Israel; Department of Sociology, Brandeis University, Waltham, MA, USA.
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Silva de Melo T, De Souza RSB. ‘’Pílula do estudo’’: uso do metilfenidato para aprimoramento cognitivo entre estudantes de psicologia da Universidade do Estado de Minas Gerais (UEMG). REVISTA CIÊNCIAS EM SAÚDE 2020. [DOI: 10.21876/rcshci.v10i2.887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objetivo: Avaliar o uso do metilfenidato para o aprimoramento cognitivo entre estudantes de Psicologia da Universidade do Estado de Minas Gerais. Métodos: Estudo epidemiológico, transversal, quantitativo. A amostra foi composta por discentes devidamente matriculados no segundo semestre de 2017 (N = 318). Os instrumentos utilizados para a avaliação foram o questionário de saúde geral, de uso do metilfenidato e o ASSIST. Resultados: A maioria dos participantes era mulher (80,8%), com idade entre 18 e 63 anos (média de 26,5 anos). Vinte e seis estudantes (8,5%) declararam já ter usado metilfenidato em algum momento na vida, doze declararam ter consumido o medicamento para fins de aprimoramento cognitivo, sendo que, destes, sete obtiveram através de amigos e nove começaram a usá-lo após o ingresso no ensino superior. Ter sono regulado (36%), tomar café (35,6%) e praticar exercícios físicos (17%) também foram mencionadas como estratégias adotadas para aumentar a capacidade cognitiva e rendimento acadêmico. O uso do metilfenidato esteve correlacionado ao uso de tabaco (r = 0,12; p < 0,05), anfetamina ou ecstasy (r = 0,20; p < 0,01), inalantes (r = 0,13; p < 0,05) e alucinógenos (r = 0,22; p < 0,01). Conclusão: O uso do metilfenidato para o aprimoramento cognitivo tem ocorrido entre os estudantes de Psicologia. Como proposta de intervenção, sugere-se a implementação de ações que promovam a escuta, o acolhimento, o debate e a reflexão desses estudantes, visando auxiliá-los no manejo das dificuldades da vida acadêmica, amenizando assim, os possíveis impactos ocasionados pelo uso do medicamento.
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[Circulation of information on drugs and other substances to increase cognitive performance: a study of a Brazilian blog (2015-2017)]. Salud Colect 2020; 16:e2514. [PMID: 32574462 DOI: 10.18294/sc.2020.2514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 04/14/2020] [Indexed: 11/24/2022] Open
Abstract
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.
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Brandão ER. Tênues direitos: sexualidade, contracepção e gênero no Brasil1. ANUÁRIO ANTROPOLÓGICO 2020. [DOI: 10.4000/aa.5766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Wilson N, Pope C, Roberts L, Crouch R. Limited pharmaceuticalisation: a qualitative case study of physiotherapist prescribing practices in an NHS Trust in England following the expansion of non-medical prescribing in the UK. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:643-659. [PMID: 31845366 DOI: 10.1111/1467-9566.13050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Over the last quarter century, non-medical prescribing in the UK has grown significantly; eight non-medical professional groups now have authority to prescribe a wide range of medicines, suggesting it could be a potent driver of pharmaceuticalisation. In this article, we present data from a case study of physiotherapists' prescribing practices. UK physiotherapists have had legal rights to prescribe medicines since 2005, but relatively little is known about the contribution they make to expanding patient access to medicines. We approached our study through a lens of governmentality to capture the mentalities and micro-practices governing physiotherapist non-medical prescribing. Ethnographic methods were used to gather data from an outpatient orthopaedic service in an NHS Trust in England employing physiotherapist prescribers. From the data, we identified a grid of intelligibility - an organising framework formulated by powerful discourses and technologies of government through which physiotherapist prescribing was acted into being. A primary effect of this grid was the constitution of new physiotherapist subjectivities, mostly as non-prescribers of medicines contrary to policy intentions, underpinned by a familiar and enduring template of medical professionalism.
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Affiliation(s)
- Nicky Wilson
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Catherine Pope
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Lisa Roberts
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Robert Crouch
- School of Health Sciences, University of Southampton, Southampton, UK
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Sultan A, Hupli A. Editorial. DRUGS AND ALCOHOL TODAY 2020. [DOI: 10.1108/dat-03-2020-075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Horter S, Seeley J, Bernays S, Kerschberger B, Lukhele N, Wringe A. Dissonance of Choice: Biomedical and Lived Perspectives on HIV Treatment-Taking. Med Anthropol 2020; 39:675-688. [PMID: 32078396 DOI: 10.1080/01459740.2020.1720981] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Treat-all recommends prompt treatment initiation for those diagnosed HIV positive, requiring adaptations to individuals' behavior and practice. Drawing on data from a longitudinal qualitative study in Eswatini, we examine the choice to initiate treatment when asymptomatic, the dissonance between the biomedical logic surrounding Treat-all and individuals' conceptions of treatment necessity, and the navigation over time of ongoing engagement with care. We reflect on the perspectives of healthcare workers, responsible for implementing Treat-all and holding a duty of care for their patients. We explore how the potentially differing needs and priorities of individuals and the public health agenda are navigated and reconciled. Rationalities regarding treatment-taking extend beyond the biomedical realm, requiring adjustments to sense of self and identity, and decision-making that is situated and socially embedded. Sense of choice and ownership for this process is important for individuals' engagement with treatment and care.
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Affiliation(s)
- Shona Horter
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine , London, UK.,Research Department, Medecins Sans Frontieres , Nhlangano, Swaziland
| | - Janet Seeley
- Global Health and Development, London School of Hygiene and Tropical Medicine , London, UK.,MRC/UVRI Uganda Research Unit On AIDS , Entebbe, Uganda
| | - Sarah Bernays
- The University of Sydney School of Public Health , Sydney, Australia
| | | | | | - Alison Wringe
- Department of Population Health, London School of Hygiene and Tropical Medicine , London, UK
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Mulinari S, Vilhelmsson A. Revisiting the pharmaceuticalisation of pandemic influenza using Lukes' framework of power. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:327-341. [PMID: 31602672 DOI: 10.1111/1467-9566.13006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The power of social actors to drive or block pharmaceutical uptake has been a concern in sociological debates on pharmaceuticalisation, including in the case of pandemic vaccination. We build on Steven Lukes' three-dimensional view of power to explore the 2009 H1N1 pandemic vaccination in Sweden and Denmark - two similar countries that arrived at conflicting vaccination strategies. Drawing on interviews with members of each country's pandemic steering group and on document analysis, we explore three consecutive stages of pandemic vaccination response: planning, vaccine procurement and the vaccination campaign. The paper makes two contributions to studies of pharmaceuticalisation and pandemics. Conceptually, we advocate the suitability of Lukes' framework over the 'countervailing powers' framework repeatedly used to model power in the pharmaceutical field. Empirically, our study confirms that government-appointed experts steered pandemic planning in both countries, but we show that the state, industry and the WHO also exerted power by enabling and constraining experts' decision-making, including by keeping some information secret. Furthermore, we argue that mass vaccination in Sweden was a pervasive expression of state power, in Lukes' sense, since it rested on keeping latent the tension between many individuals' health interests and the state's interests in protecting social and economic functioning.
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Affiliation(s)
- Shai Mulinari
- Department of Sociology, Lund University, Lund, Sweden
| | - Andreas Vilhelmsson
- Department of Sociology, Lund University, Lund, Sweden
- Division of Social Medicine and Global Health, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
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Hupli A. Cognitive enhancement with licit and illicit stimulants in the Netherlands and Finland: what is the evidence? DRUGS AND ALCOHOL TODAY 2020. [DOI: 10.1108/dat-07-2019-0028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
European studies have shown lower prevalence rates of prescription stimulant use for cognitive enhancement, especially among student populations, compared to North America. This difference requires more cross-country research of the various factors involved. To find out whether other parts of the globe are witnessing similar increases in extra-medical stimulant use, and how this might relate to cognitive enhancement, requires empirical study of local contexts. This paper aims to argue that the academic and public discussion on cognitive enhancement should consider the specific country context of drug policy and research and rethink which drugs are included under the term cognitive enhancement drugs.
Design/methodology/approach
This paper offers a general review and a sociological country comparison between the Netherlands and Finland, focusing not only on prescription stimulants used to treat attention deficit hyperactivity disorder but also illicit amphetamines among young adults and methylphenidate use among Dutch and Finnish participants of the Global Drug Survey. This paper emphasises sociocultural perspectives and the importance of context in cognitive enhancement in general as the line between therapeutic and enhancement use can often be blurred. Data is drawn from global, European and national sources, including the International Narcotics Control Board, European Monitoring Centre for Drugs and Drug Addiction and Global Drug Survey.
Findings
There are hardly any national empirical studies done on cognitive enhancement drug use in Finland. On the other hand, there have been studies in the Netherlands showcasing that the use of prescription stimulants and other drugs for enhancement purposes is something that is happening among young people, albeit yet in a relatively small scale. Illicit and licit stimulant use and drug policy action in relation to cognitive enhancement drugs in the two countries varies, emphasising the importance of country context.
Originality/value
Given that cross-country research is scarce, this general review provides one of the first glimpses into cognitive enhancement drug use by comparing the country context and research in Finland, where the phenomenon has not been studied, with the Netherlands, where the topic has received more research and public attention. Further research areas are suggested.
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Castro BD. Aprimoramento cognitivo e a produção de modos de subjetividade: um estudo sobre o uso de substâncias “nootrópicas” a partir de um blog brasileiro. SAUDE E SOCIEDADE 2020. [DOI: 10.1590/s0104-12902020190936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
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.
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Reichenpfader U, Wickström A, Abrandt Dahlgren M, Carlfjord S. 'In the hospital all is taken care of': a practice-theoretical approach to understand patients' medication use. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:50-64. [PMID: 31423622 DOI: 10.1111/1467-9566.12985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Drawing from case examples of medication review implementation in three hospital settings in Sweden, this article examines patients' medication use. Based on a practice theory approach and utilising data from interviews with patients and participant observation, we reconstruct three practices of everyday medication use centring on accepting, challenging or appropriating medication orders. This article argues that patients' medication practices are embedded in wider practice arrangements that afford different modes of agency. Reconceptualising patients' medication use from a practice-based perspective revealed the meaning-making, order-producing and identity-forming features of these practices. Also, we illustrated how different modes of agency were achieved in patients' medication practices, suggesting a fluidity of both the meanings attached to and the identities related to medication use. Our findings have practical implications as these practices of medication use can be transformed when altering the arrangements they are embedded in, thus going beyond the clinical encounter.
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Affiliation(s)
- Ursula Reichenpfader
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Anette Wickström
- Department of Thematic Studies - Child Studies, Linköping University, Linköping, Sweden
| | | | - Siw Carlfjord
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Hupli A, Didžiokaitė G, Ydema M. Beyond Treatment Versus Enhancement: A Qualitative Study of Pharmacological Neuro-Enhancement Among Dutch and Lithuanian University Students. ACTA ACUST UNITED AC 2019. [DOI: 10.1177/0091450919884777] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This article examines the ambiguous relationship between treating illness and enhancing normalcy through the use of “cognitive enhancement” drugs. Although the literature on pharmacological neuro-enhancement generally differentiates between the “licit/therapeutic” and “illicit/enhancement” use of substances, in-depth interviews with 35 university students in the Netherlands and Lithuania—both with and without formal medical diagnoses of (mainly) Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder—reveal the fluidity of these categories. Our study of the perceptions and experiences of people who use such drugs further suggests a much broader range of substances, motives, and sought-after effects than are commonly acknowledged in the “cognitive enhancement” literature. We need a more inclusive and context-sensitive approach to study pharmacological neuro-enhancement, for instance, by approaching both licit and illicit drugs as tools or instruments.
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Affiliation(s)
- Aleksi Hupli
- School of Social Science and Humanities, University of Tampere, Finland
| | | | - Marte Ydema
- Amsterdam Institute for Social Science Research, University of Amsterdam, the Netherlands
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Serapioni M. Franco Basaglia: biography of a revolutionary. ACTA ACUST UNITED AC 2019; 26:1169-1187. [PMID: 31800834 DOI: 10.1590/s0104-59702019000400008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 08/06/2018] [Indexed: 11/21/2022]
Abstract
1978-2018: 40 years since the passing of the Basaglia law, which decreed the closure of psychiatric hospitals in Italy (where almost hundred thousand were confined), the primary goal of Franco Basaglia in his lifelong struggle against the violence of total institutions and, in particular, mental asylums. This article offers a reflection on the human, intellectual, and professional trajectory of Basaglia, highlighting his criticisms of the backwardness of university clinics, his interest in the therapeutic dimension of care (Binswanger and Minkowski), the influence on his thinking of European philosophy more open to the complexity of the human being (Husserl, Jaspers, Merleau-Ponty, and Sartre), and his encounter with historical (Foucault), sociological (Goffman), and anti-institutional (Fanon) perspectives on mental health.
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Affiliation(s)
- Mauro Serapioni
- Investigador, Centro de Estudos Sociais/Universidade de Coimbra. Coimbra - Portugal
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46
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Leibing A. Geriatrics and humanism: Dementia and fallacies of care. J Aging Stud 2019; 51:100796. [PMID: 31761098 DOI: 10.1016/j.jaging.2019.100796] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 07/01/2019] [Indexed: 11/24/2022]
Abstract
Based on fieldwork in a specialized geriatric outpatient clinic in Brazil, this article shows how a humanistic discourse that 'means well' can do good, but can also produce a regime of care that ultimately results in care that is contrary to stated values. These values - such as holistic care, multidisciplinarity, and empathy - that have been at the heart of geriatrics since its more official founding in the 1940s and 1950s, cannot be conceived as only local. The Brazilian data mirrors international geriatric values and norms, which, however, are being applied here in a specific context, in a country perceived as 'young' and with limited resources for elder care. Fallacies of care in this context result preliminary from a translation of more structural factors as individualized (self-)care and from the abstraction and generalization of aging individuals as 'older people'.
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Affiliation(s)
- Annette Leibing
- Faculté des sciences infirmières, Université de Montréal, CP 6128, succursale Centre-ville, Montreal, QC H3C 3J7, Canada.
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47
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Brandão ER. Contraception d’urgence au Brésil : la grammaire du risque dans un pays inégalitaire. ANTHROPOLOGIE ET SANTÉ 2019. [DOI: 10.4000/anthropologiesante.5210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Byrne P, O’Donovan Ó, Smith SM, Cullinan J. Medicalisation, risk and the use of statins for primary prevention of cardiovascular disease: a scoping review of the literature. HEALTH RISK & SOCIETY 2019. [DOI: 10.1080/13698575.2019.1667964] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Paula Byrne
- National University of Ireland, Galway, Ireland
| | | | - Susan M Smith
- Royal College of Surgeons in Ireland, Dublin, Ireland
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49
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Rohden F. Adjusting hormones and constructing desires: new materialisations of female sexuality in Brazil. CULTURE, HEALTH & SEXUALITY 2019; 21:1045-1058. [PMID: 30612507 DOI: 10.1080/13691058.2018.1534141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 10/06/2018] [Indexed: 06/09/2023]
Abstract
This paper presents the findings from a study conducted in Brazil among doctors specialised in the treatment of sexual problems. Its focus is on medical treatments and approaches related to female sexuality. According to the accounts provided by professionals, the most common 'problem' they encountered among women was lack of sexual desire in the period around menopause. In line with current principles of sexual medicine, they concurred that this issue resulted from declining hormone production. This paper discusses how pharmaceutical treatments have facilitated the materialisation of female desire in terms of the presence or absence of testosterone, paradoxically the hormone most commonly associated with masculinity.
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Affiliation(s)
- Fabíola Rohden
- a Department of Anthropology , Federal University of Rio Grande do Sul , Porto Alegre , Brazil
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50
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Mintz D. Recovery from Childhood Psychiatric Treatment: Addressing the Meaning of Medications. Psychodyn Psychiatry 2019; 47:235-256. [PMID: 31448987 DOI: 10.1521/pdps.2019.47.3.235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
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.
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Affiliation(s)
- David Mintz
- Director of Psychiatric Education/Associate Director of Training/Team Leader, Austen Riggs Center
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