Uncertain and under Quarantine: Toward a Sociology of Medical Ignorance

Making sense of a pandemic: reasoning about COVID-19 in the intellectual dark web

In this study, I examine how users of an online Reddit community, r/IntellectualDarkWeb, forged an anti-establishment collective identity through practices of "heterodox scientific" reasoning. I do so through a discursive analysis of comments and posts made to r/IntellectualDarkWeb during the COVID-19 pandemic. First, I deploy the BERTopic algorithm to cluster my corpus and surface topics pertaining to COVID-19. Second, I engage in a qualitative content analysis of the relevant clusters to understand how discourses about COVID-19 were mobilized by subreddit users. I show that discussions about COVID-19 were polarized along "contrarian" and "anti-contrarian" lines, with significant implications for the subreddit's process of collective identity. Overwhelmingly, contrarian content that expressed skepticism towards vaccines, mistrust towards experts, and cynicism about the medical establishment was affirmed by r/IntellectualDarkWeb users. By contrast, anti-contrarian content that sought to counter anti-vaccine rhetoric, defend expertise, or criticize subreddit users for their contrarianism was penalized. A key factor in this dynamic was Reddit's scoring mechanism, which empowered users to publicly upvote contrarian affirming content while simultaneously downvoting anti-contrarian content. As users participated in sense making about COVID-19, they deployed Reddit's scoring mechanism to reinforce a contrarian collective identity oriented around a practice of heterodox science. My research shows the continued relevance of the concept of collective identity in the digital age and its utility for understanding contemporary reactionary social movements.

The gender of PrEP: Transgender men negotiating legitimacy in France

Transmasculine people (TM) constitute an invisibilized group within the transgender population. Little is known about their relationship to sexuality in transgender medicine. Their presence and needs are still unacknowledged within HIV prevention research and services. Pre-exposure prophylaxis (or PrEP) is an oral medication that prevents HIV in HIV-negative individuals at risk of infection with the virus. This paper proposes to bring TM back into the focus of PrEP research by questioning how they navigate and situate themselves in relation to existing PrEP categorization and services, and how they think about and (re)shape the meanings of PrEP. It is based on the "interpretative descriptive" method and a transfeminist theoretical framework applied to the analysis of ten semi-structured interviews with TM conducted in France between 2019 and 2023. Findings show that PrEP is gendered. We identify specific barriers to getting PrEP as well as to access healthcare and we show that a cisnormative and homonormative approach to prevention generates them. PrEP use and PrEP disclosure are embedded in structural and symbolic power relations between cisgender and transgender MSM that are reflected in the intimate sphere. TM use PrEP to prevent sexual assault and to alleviate the difficulty of condom negotiation. PrEP comes into play following major changes in TM's sexualities and is integrated post-exposure.

When patients demur: Resisting diagnostic closure in US primary care

Patients are more engaged in their healthcare than ever before, including in the process of diagnostic sensemaking. But in acute primary care encounters, the interactional flow of the visit is shaped by an orientation toward the physician as the authority over diagnostic reasoning. Once physicians close diagnostic inquiry and transition into counseling, their assessment - and the extent to which it converges with the patient's perspective - comes into full view. Yet this is precisely when patients have reduced occasions to speak up if they do have concerns, as the "train has left the station" both diagnostically and interactionally. Using conversation analysis and a dataset of 75 video recordings of acute primary care encounters in the US, this article examines how patients speak up in this constrained environment. The concept of diagnosis demurral is proposed to describe how patients resist diagnostic closure by renewing the relevance of diagnostic inquiry, either in response to a diagnosis or at any point following the transition into counseling. Findings suggest that patients demur more frequently than prior studies on diagnosis resistance may have predicted, but they do so in ways that maintain deference to the physician's authority over matters of diagnosis: speaking up primarily outside the diagnostic moment, relying on actions in their own domain of expertise (e.g., their illness experience), and working to additionally soften the epistemic and interactional inappositeness of their demurral. This behavior sits at the nexus of two opposing forces: patients may be more engaged, but their participation is constrained by a continued legacy of medical authority over diagnosis, to which patients themselves continue to respond and reproduce.

The long tail of COVID and the tale of long COVID: Diagnostic construction and the management of ignorance

We bring together insights from the sociology of diagnosis and the sociology of ignorance to examine the early diagnostic unfolding of 'Long COVID' (LC). Originally described by patient activists, researchers set out to ponder its unwieldy clinical boundaries. Using a scoping review method in tandem with qualitative content analytic techniques, we analyse medicine's initial struggles to construct a LC diagnosis. Paying attention to the dynamics of ignorance, we highlight three consequential conceptual manoeuvres in the early classifications of LC: causal agnosticism concerning the relationship between COVID-19 and LC, evasion of lumping LC with similar conditions; and the predictable splitting off of medically explainable cases from the LC designation. These manoeuvres are not maleficent, inept or unreasonable. They are practical but impactful responses to the classificatory dilemmas present in the construction of diagnoses amidst ignorance. Although there are unique aspects to LC, we suggest that its early fate is nevertheless emblematic of medicine's diagnostic standardisation processes more generally. To varying degrees, diagnoses are ignorance management strategies; they create a pathway through the uncertainty at the core of disease realities. However, while diagnoses circumscribe some types of ignorance, they produce others through the creation of blind spots and paths not taken.

AstraZeneca Vaccine Controversies in the Media: Theorizing About the Mediatization of Ignorance in the Context of the COVID-19 Vaccination Campaign

As is the case in other situations of deep uncertainty, the unknowns related to the COVID-19 pandemic have aroused a great deal of attention in the media. Drawing insights both from mediatization theory and ignorance studies, we discuss the coverage of the AstraZeneca vaccine controversies to develop a new concept that we call the mediatization of ignorance. In doing so, we conceptualize the procedure through which unknowns become mediatized as a three-step process that results from a combination of logics from the areas of politics, health, and science/industry. Moreover, we argue that the mediatization of ignorance may have promoted vaccine hesitancy at a moment when vaccination was crucial for addressing the COVID-19 pandemic. We conclude by suggesting the need to explore in further detail the role that ignorance plays not only in the management of the COVID-19 crisis but also in different areas of society.

Postdigital health practices: new directions in medical humanities

Digitalisation has changed the way we understand and practice health. The recent pandemic has accelerated some of the developments in digital health and brought about modifications in public access to information. Taking this into consideration, this programmatic paper sets the stage for and conceptualises postdigital health practices as a possible field of inquiry within medical humanities. While delineating some central aspects of said practices, I draw attention to their significance in contemporary strategies of knowledge production. Spotlighting online environments as the point of ingress for the analysis of these practices, I propose three possible foci of critical and methodological engagement. By spotlighting the serialisation, multimodality, and transmediality of such environments, I argue, we have a chance to both augment and go beyond the field's long-standing preoccupation with narrative, attend to various strategies of communicating illness experience, and re-frame them within larger questions of systemic inequalities. On this basis, and taking as examples COVID-19 and Long COVID, I sketch some of the directions that future strands of medical humanities may take and some of the questions we still have to ask for the field to overcome its own biases and blind spots.

Temporal uncertainty in disease diagnosis

There is a profound paradox in modern medical knowledge production: The more we know, the more we know that we (still) do not know. Nowhere is this more visible than in diagnostics and early detection of disease. As we identify ever more markers, predictors, precursors, and risk factors of disease ever earlier, we realize that we need knowledge about whether they develop into something experienced by the person and threatening to the person's health. This study investigates how advancements in science and technology alter one type of uncertainty, i.e., temporal uncertainty of disease diagnosis. As diagnosis is related to anamnesis and prognosis it identifies how uncertainties in all these fields are interconnected. In particular, the study finds that uncertainty in disease diagnosis has become more subject to prognostic uncertainty because diagnosis is more connected to technologically detected indicators and less closely connected to manifest and experienced disease. These temporal uncertainties pose basic epistemological and ethical challenges as they can result in overdiagnosis, overtreatment, unnecessary anxiety and fear, useless and even harmful diagnostic odysseys, as well as vast opportunity costs. The point is not to stop our quest for knowledge about disease but to encourage real diagnostic improvements that help more people in ever better manner as early as possible. To do so, we need to pay careful attention to specific types of temporal uncertainty in modern diagnostics.

'Don't think that we die from AIDS': Invisibilised uncertainty and global transgender health

The invisibilisation of social groups in health research and survey data is a source of medical uncertainty, long seen as a hallmark of the medical field. However, scholarship has not thoroughly assessed how medical uncertainty is structured by state-level processes and global health agendas, especially for people beyond the Global North. This article introduces invisibilised uncertainty as a type of medical uncertainty structured by global organisational and state-level priorities, which can invisibilise social groups and health problems from research and data collection, exacerbating medical uncertainty and health disparities for people worldwide. Based on 14 months of fieldwork in Thailand and in-depth interviews with 62 participants, the article illuminates how state-level processes and global clinical research agendas have structured knowledge gaps and uncertainties for Thai transgender women. As omissions in health research and data collection become embodied on a world scale, the article expands our understandings of how gendered health disparities are structured nationally and globally. It advances a sociology of medical ignorance by analysing the uneven landscape of holistic transgender health research, parsing how institutional dynamics can prioritise or invisibilise people and health issues in research and data, and structure uncertainties.