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Turrini M, Bourgain C. Appraising screening, making risk in/visible. The medical debate over Non-Rare Thrombophilia (NRT) testing before prescribing the pill. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:1627-1642. [PMID: 34293180 DOI: 10.1111/1467-9566.13348] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 06/07/2021] [Accepted: 06/18/2021] [Indexed: 06/13/2023]
Abstract
Non-rare thrombophilia (NRT) are hereditary predispositions to thromboembolism, the most severe side effect of combined hormonal contraception. In the mid-1990s, the identification of NRT stirred up a controversy over the possibility of investigating these genetic variants in women wishing to use contraception. Through a review of literature, this article reconstructs the debate over whether and how this genetic test should be prescribed as a way to reconfigure the risk visibility on pharmacological contraception. The main arguments identified concern the epidemiological, social, economic and clinical aspects of the test. In a context where the overall thrombotic risk for hormonal contraception is largely invisible, the genetic tests turn to embody the thrombotic risk itself. Those who opt for selective screening argue that a better estimation of risk implies a test prescription embed in a global medical assessment of women's individual risk. To advocates of universal or 'extended' screening, the tests are valuable tools to inform women on the thrombotic risk and, as such, appraised as a moral/legal obligation, whatever their predictive power. Risk visibility thus appears as an insightful concept to analyse a complex setting associating clinical, political, social and cultural considerations that touches upon medical power, women's responsibility and drug safety.
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Degeling C, McEwin EJ, Moynihan R, Carter SM. The introduction and demise of full-body computed tomography (CT) scanning in Australia: implications for preventing overdiagnosis. CRITICAL PUBLIC HEALTH 2020. [DOI: 10.1080/09581596.2020.1841115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Chris Degeling
- Australian Centre for Health Engagement, Evidence and Values, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
- Sydney School of Public Health, Wiser Healthcare, Sydney, Australia
| | - Eliza J. McEwin
- Sydney School of Public Health, Wiser Healthcare, Sydney, Australia
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Ray Moynihan
- Sydney School of Public Health, Wiser Healthcare, Sydney, Australia
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Stacy M. Carter
- Australian Centre for Health Engagement, Evidence and Values, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
- Sydney School of Public Health, Wiser Healthcare, Sydney, Australia
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Hogarth S, Löblová O. Regulatory niches: Diagnostic reform as a process of fragmented expansion. Evidence from the UK 1990–2018. Soc Sci Med 2020; 304:113363. [DOI: 10.1016/j.socscimed.2020.113363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/03/2020] [Accepted: 09/10/2020] [Indexed: 11/15/2022]
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Abstract
Next generation DNA sequencing (NGS) has the potential to improve the diagnostic and prognostic utility of newborn screening programmes. This study assesses the feasibility of automating NGS on dried blood spot (DBS) DNA in a United Kingdom National Health Service (UK NHS) laboratory. An NGS panel targeting the entire coding sequence of five genes relevant to disorders currently screened for in newborns in the UK was validated on DBS DNA. An automated process for DNA extraction, NGS and bioinformatics analysis was developed. The process was tested on DBS to determine feasibility, turnaround time and cost. The analytical sensitivity of the assay was 100% and analytical specificity was 99.96%, with a mean 99.5% concordance of variant calls between DBS and venous blood samples in regions with ≥30× coverage (96.8% across all regions; all variant calls were single nucleotide variants (SNVs), with indel performance not assessed). The pipeline enabled processing of up to 1000 samples a week with a turnaround time of four days from receipt of sample to reporting. This study concluded that it is feasible to automate targeted NGS on routine DBS samples in a UK NHS laboratory setting, but it may not currently be cost effective as a first line test.
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Belardo MB, Camargo Junior KRD. Tamizaje masivo: una revisión de la literatura sociológica. SAÚDE EM DEBATE 2018. [DOI: 10.1590/0103-1104201811818] [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
RESUMEN Se provee una revisión de la literatura sociológica a partir de 79 obras referentes a cribados de cáncer y se excluyeron los cribados genéticos prenatal y neonatal. El tamizaje implica el monitoreo de poblaciones aparentemente sanas para rastrear una determinada condición. El rastreo invirtió la concepción tradicional de comprensión sobre las enfermedades al disminuir los umbrales de definición de enfermedad y rompió con la distinción médica tradicional entre enfermos y sanos. A partir de entonces, la práctica clínica comenzó a buscar enfermedades en personas asintomáticas, y así también modificó los comportamientos de los pacientes, que pasaron a ser responsables del cuidado de sí mismos.
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Kerr A, Ross E, Jacques G, Cunningham‐Burley S. The sociology of cancer: a decade of research. SOCIOLOGY OF HEALTH & ILLNESS 2018; 40:552-576. [PMID: 29446117 PMCID: PMC5901049 DOI: 10.1111/1467-9566.12662] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Biomedicine is often presented as the driving force behind improvements in cancer care, with genomics the latest innovation poised to change the meaning, diagnosis, treatment, prevention and lived experience of cancer. Reviewing sociological analyses of a diversity of patient and practitioner experiences and accounts of cancer during the last decade (2007-17), we explore the experiences of, approaches to and understandings of cancer in this period. We identify three key areas of focus: (i) cancer patient experiences and identities; (ii) cancer risk and responsibilities and (iii) bioclinical collectives. We explore these sociological studies of societal and biomedical developments and how sociologists have sought to influence developments in cancer identities, care and research. We end by suggesting that we extend our understanding of innovations in the fields of cancer research to take better account of these wider social and cultural innovations, together with patients, activists' and sociologists' contributions therein.
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Affiliation(s)
- Anne Kerr
- School of Sociology and Social PolicyUniversity of LeedsUK
| | - Emily Ross
- The Usher InstituteEdinburgh Medical SchoolUniversity of EdinburghUK
| | - Gwen Jacques
- School of Sociology and Social PolicyUniversity of LeedsUK
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Buchbinder M. Keeping out and getting in: reframing emergency department gatekeeping as structural competence. SOCIOLOGY OF HEALTH & ILLNESS 2017; 39:1166-1179. [PMID: 28422296 PMCID: PMC5600633 DOI: 10.1111/1467-9566.12566] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Sociologists have tended to frame medical gatekeeping as an exclusionary social practice, delineating how practitioners and clerical staff police the moral boundaries of medicine by keeping out patients who are categorised as 'bad', 'deviant', or otherwise problematic. Yet medical gatekeeping, understood more broadly, can include not only keeping patients out of particular clinical settings, but also redirecting them to alternative sources of care. In this article, I draw on qualitative analysis of audio-recorded patient-provider interactions in a United States emergency department (ED) to illustrate medical gatekeeping as a two-step process of, first, categorising certain patient complaints as unsuitable for treatment within a particular setting, and second, diverting patients to alternative sites for care. I refer to these as the restrictive and facilitative components of medical gatekeeping to denote how each relates to patients' access to care, recognising that both components of medical gatekeeping are part of a coordinated organisational strategy for managing resource scarcity. By illustrating how ED providers reveal intimate knowledge of structural vulnerabilities in diverting socioeconomically disadvantaged patients with chronic back pain to clinical sites that are better equipped to provide care, I suggest that we rethink the emphasis on restrictive practices in sociological accounts of medical gatekeeping.
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Affiliation(s)
- Mara Buchbinder
- Department of Social Medicine, Center for Bioethics, University of North Carolina, Chapel Hill, USA
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Stol YH, Schermer MHN, Asscher ECA. Omnipresent Health Checks May Result in Over-responsibilization. Public Health Ethics 2016. [DOI: 10.1093/phe/phw034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Haddow G, King E, Kunkler I, McLaren D. Cyborgs in the Everyday: Masculinity and Biosensing Prostate Cancer. SCIENCE AS CULTURE 2015; 24:484-506. [PMID: 27335534 PMCID: PMC4894087 DOI: 10.1080/09505431.2015.1063597] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
An in vivo biosensor is a technology in development that will assess the biological activity of cancers to individualise external beam radiotherapy. Inserting such technology into the human body creates cybernetic organisms; a cyborg that is a human-machine hybrid. There is a gap in knowledge relating to patient willingness to allow automated technology to be embedded and to become cyborg. There is little agreement around what makes a cyborg and less understanding of the variation in the cyborgisation process. Understanding the viewpoint of possible beneficiaries addresses such gaps. There are currently three versions of 'cyborg' in the literature (i) a critical feminist STS concept to destabilise power inherent in dualisms, (ii) an extreme version of the human/machine in science-fiction that emphasises the 'man' in human and (iii) a prediction of internal physiological adaptation required for future space exploration. Interview study findings with 12 men in remission from prostate cancer show a fourth version can be used to describe current and future sub-groups of the population; 'everyday cyborgs'. For the everyday cyborg the masculine cyborg status found in the fictionalised human-machine related to issues of control of the cancer. This was preferred to the felt stigmatisation of being a 'leaker and bleeder'. The willingness to become cyborg was matched with a having to get used to the everyday cyborg's technological adaptations and risks. It is crucial to explore the everyday cyborg's sometimes ambivalent viewpoint. The everyday cyborg thus adds the dimension of participant voice currently missing in existing cyborg literatures and imaginations.
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Affiliation(s)
- Gill Haddow
- Science, Technology and Innovation Studies, The University of Edinburgh, Edinburgh, UK
| | - Emma King
- Midwifery and Allied Health Professionals Research Unit (NMAHP-RU), University of Stirling, Stirling, UK
| | - Ian Kunkler
- Edinburgh Cancer Centre, The University of Edinburgh, Edinburgh, UK
| | - Duncan McLaren
- Edinburgh Cancer Centre, The University of Edinburgh, Edinburgh, UK
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Vassy C, Rosman S, Rousseau B. From policy making to service use. Down's syndrome antenatal screening in England, France and the Netherlands. Soc Sci Med 2014; 106:67-74. [DOI: 10.1016/j.socscimed.2014.01.046] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 01/20/2014] [Accepted: 01/24/2014] [Indexed: 10/25/2022]
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Rychetnik L, Carter SM, Abelson J, Thornton H, Barratt A, Entwistle VA, Mackenzie G, Salkeld G, Glasziou P. Enhancing Citizen Engagement in Cancer Screening Through Deliberative Democracy. J Natl Cancer Inst 2013; 105:380-6. [DOI: 10.1093/jnci/djs649] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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