Patient-led research and displacements of biomedical knowledge production, distribution, and consumption

Patient and Public Involvement in Research (PPIR) has become an increasingly prevalent and integral part of biomedical research. In this paper, we focus on patient-led research, taking as our case the construction of new biomedical knowledge regarding the rare disease ADNP syndrome. Specifically, we seek to understand how concepts of experiential knowledge and lay expertise become integral to rather than separate from scientific expertise. In the case of ADNP, the parent-led research "mimes" biomedical knowledge practices in a way that, on the one hand, enhances the legitimacy of science and scientific expertise, and on the other displaces and transforms science by the fact that other knowledge agents (patients, next-of-kin) enter these practices.

Health activism, vaccine, and mpox discourse: BERTopic based mixed-method analyses of tweets from sexual minority men and gender diverse (SMMGD) individuals in the U.S

Objectives

To synthesize discussions among sexual minority men and gender diverse (SMMGD) individuals on mpox, given limited representation of SMMGD voices in existing mpox literature.

Methods

BERTopic (a topic modeling technique) was employed with human validations to analyze mpox-related tweets (n = 8,688; October 2020-September 2022) from 2,326 self-identified SMMGD individuals in the U.S.; followed by content analysis and geographic analysis.

Results

BERTopic identified 11 topics: health activism (29.81%); mpox vaccination (25.81%) and adverse events (0.98%); sarcasm, jokes, emotional expressions (14.04%); COVID-19 and mpox (7.32%); government/public health response (6.12%); mpox symptoms (2.74%); case reports (2.21%); puns on the virus' naming (i.e., monkeypox; 0.86%); media publicity (0.68%); mpox in children (0.67%). Mpox health activism negatively correlated with LGB social climate index at U.S. state level, ρ = -0.322, p = 0.031.

Conclusions

SMMGD discussions on mpox encompassed utilitarian (e.g., vaccine access, case reports, mpox symptoms) and emotionally-charged themes-advocating against homophobia, misinformation, and stigma. Mpox health activism was more prevalent in states with lower LGB social acceptance.

Public Health Implications

Findings illuminate SMMGD engagement with mpox discourse, underscoring the need for more inclusive health communication strategies in infectious disease outbreaks to control associated stigma.

Sexual health activism: the motivations of near-peer volunteer educators working to promote positive understandings of gender and sexuality in UK secondary schools

This paper explores and theorises education-based workshops delivered in secondary schools in support of a relationships and sex education curriculum that aims to bring forth more positive understandings and experiences of gender and sexuality. We cast this work as a form of sexual health activism, with our paper deepening understanding of how the motivations of those engaged in this form of activism interface with the decision to invest time in this work. Based on interviews with 40 workshop facilitators in England and Wales we argue that this form of sexual health activism is motivated by facilitators' life experiences as well as the desire to make the world a better place. As such, this form of work can function as a means of 'caring for' both past selves and future generations, thus functioning simultaneously as a form of self-care and a form of 'societal care work'. Ultimately, these activities may be understood as a form of 'extra-clinical' healthcare practice, with leading gender and sexual health workshops serving as an important means of solidifying health students' identities as both healthcare providers and activists for social change.

"There Are Many of Us": Online Testimonies From "Pill Victims" as a New Form of Health Activism

The French pill scare is usually presented as a "media debate" triggered by the case of Marion Larat, a young woman who suffered a stroke attributed to the pill she was taking. This article intends to focus on a practice that preceded, accompanied, and followed this health scare: the publication of online testimonies of thrombotic reactions posted on the website of the French Association of Victims of Pulmonary Embolism and Stroke Associated with Hormonal Contraception (Avep). Through a discourse analysis, we intend to analyze these online public self-reports as an activist practice aimed at criticizing the dominant medical discourse on contraception. Four discursive frames emerged: unpreparedness of women and doctors, denial of blame and search for the cause, breaking the silence and building solidarity, and collective action. The first two frames concern the process women put in place to obtain the right to speak about and criticize a medical practice. The right to speak is achieved through a concise narrative style focusing on facts, bodily manifestations, and risk factors. The second pair refers to the formation of pill victims as subjects with an ambivalent status and ephemeral agency. The testimonies build what we call "lone solidarity", that is, the creation of a social bond and action around a common experience of witnessing medical injustice that develops without any exchange between members. This proves to be inclusive and viral, but at the same time fiercely anti-representational with respect to political struggles or social identification.

Environmental Justice: Where It Has Been, and Where It Might Be Going

Taking stock of environmental justice (EJ) is daunting. It is at once a scholarly field, an ongoing social movement, and an administrative imperative adopted by government agencies and incorporated into legislation. Moreover, within academia, it is multidisciplinary and multimethodological, comprising scholars who do not always speak to one another. Any review of EJ is thus necessarily restrictive. This article explores several facets of EJ activism. One is its coalitional and "inside-outside" orientation. EJ activists are constantly forming alliances with other stakeholders, but these coalitions do not flout the importance of engaging with formal institutions. The review next turns to one set of such institutions-the courts and regulatory agencies-to see how well EJ claims have fared there. I then survey scientific findings that have been influenced by EJ. The review concludes with future directions for activists and scholars to consider: the changing nature of EJ coalitions, fragmentation within EJ and with other fields, the historical roots of environmental injustice, and opportunities for stronger infusion of the EJ lens.

On the verge between the scientific and the alternative: Swedish women's claims about systemic side effects of the copper intrauterine device

The article intervenes in discussions on lay knowledge production about health in the Internet era, through the case of a group of women claiming that their use of copper intrauterine devices has led to systemic side effects. Based on online group interviews and written essays, we examine how women embracing these knowledge claims navigate various sources of information, focusing on the role of scientificity in these epistemic negotiations. The women were found to be involved in an active, scientifically oriented process of knowledge formation, which we refer to as a collective labour of scientific patchworking. Meanwhile, due to a perceived lack of scientifically based expertise on their condition, the women reported having little choice but turn to resources with weaker scientific foothold. We argue that the tendency to portray these women's claims as unscientific simplifies the nature of lay knowledge production, potentially deepening divides between medical authorities and the public.

Health activism as nursing practice: A scoping review

AIMS

The aim was to assess the current literature investigating health activism within nursing practice.

DESIGN

This was a scoping review of the literature utilizing the updated Levac et al.'s framework.

DATA SOURCE/REVIEW METHODS

A search of the CINAHL, PubMed, Scopus and Allied Health databases was conducted for peer-reviewed, English research published between January 2000 and April 2021.

RESULTS

Thirty-one articles met the criteria for inclusion in this study. The included research in nursing and health activism was heterogeneous in topic and method and primarily conducted in North America. Four themes resulted from the inductive thematic analysis: (1) Doing Health Activism, (2) Facilitators to Engaging in Health Activism, (3) Barriers to Health Activism Engagement and (4) Limited Education. Activism was not consistently defined and the term was used interchangeably with advocacy.

CONCLUSION

There is a gap between nursing scope of practice, and education and skills in health activism. There is limited research regarding health activism and what constitutes as health activism. There is an opportunity to improve health activism awareness and skills within the nursing profession and undergraduate education and to produce nursing research on health activism.

IMPACT

Health activism is integral to the nursing role, however, evidence suggests nurses lack confidence to engage in activism as practice. This is important for nurses across the world and in all care specialities.

Cultivated co-production: Sexual health, human rights, and the revision of the ICD

STS scholars frequently have shown how science and sociopolitical arrangements are 'co-produced', typically tracing how scientific actors themselves keep 'science' and 'politics' far apart. Revealing co-production is therefore deemed the work of the STS analyst, who unearths linkages that the actors might be unaware of, or might ignore or deny. By contrast, the creation of a new chapter on 'sexual health' in the recent revision of the International Classification of Diseases (ICD) offers a case of what might be termed 'cultivated co-production'. Neither oblivious to the linkages between science and politics nor invested in obscuring them, the designers of the sexual health chapter sought support for their work by demonstrating, transparently, how science, ethics, and human rights might properly be aligned. The intentional and visible character of co-production in this case indicates awareness of the need to manage the contested nature of gender and sexuality at a transnational level. It also reflects two changes in the organization of medical politics and medical classification: a widespread recognition of the necessity of reaching out to lay stakeholders and advocates, and the rise of an emphasis on 'conventions' as the backbone of transnational biomedical consensus processes.

Mapping buyer's clubs; what role do they play in achieving equitable access to medicines?

Buyer's clubs were first recognised during the HIV/AIDS pandemic in the 1980s and focussed on knowledge curation and distribution of treatments. In the past decade, there has been a resurgence of buyer's clubs, mostly focussed on hepatitis C treatment and PrEP. This paper aims to increase understanding of buyer's clubs and stimulate discussion on their role in achieving equitable access to medicines. Our proposed definition of a buyer's club is 'a community-led organisation or group which seeks to improve an individual's access to medication through knowledge sharing and/or distribution as its primary goal'. The logistical and relational infrastructures of buyer's clubs have been mapped out. Networks and communities are integral to buyer's clubs by facilitating practical aspects of buyer's clubs and creating a sense of community that serves as a foundation of trust. For a user to receive necessary medical support, doctors play a crucial role, yet, obtaining this support is difficult. Whilst buyer's clubs are estimated to have enabled thousands of people to access medicines, and they run the risk of perpetuating health inequities and injustices. They may have the potential to serve as a health activism tool to stimulate sustainable changes; however, this needs to be explored further.

The Case Against the Doctors: Gender, Authority, and Critical Science Writing in the 1960s

In the 1960s, widespread popular-cultural deference to the authority of science and medicine in the United States began to wane as a generation of journalists and activists reevaluated and criticized researchers and physicians. This article uses the career of feminist journalist Barbara Seaman to show the role that the emerging genre of critical science writing played in this broader cultural shift. First writing from her position as a mother, then as the wife of a physician, and finally as a credentialed science writer, Seaman advanced through distinct categories of journalistic authority throughout the 1960s. An investigation of Seaman's early years in the profession also vividly demonstrates the roles that gender and professional expertise played in both constricting and permitting new forms of critique during this era.

Legitimating complementary therapies in the NHS: Campaigning, care and epistemic labour

Questions of legitimacy loom large in debates about the funding and regulation of complementary and alternative medicine (CAM) in contemporary health systems. CAM’s growth in popularity is often portrayed as a potential clash between clinical, state and scientific legitimacies and legitimacy derived from the broader public. CAM’s ‘publics’, however, are often backgrounded in studies of the legitimacy of CAM and present only as a barometer of the legitimating efforts of others. This article foregrounds the epistemic work of one public’s effort to legitimate CAM within the UK’s National Health Service: the campaign to ‘save’ Glasgow’s Centre for Integrative Care (CIC). Campaigners skilfully intertwined ‘experiential’ knowledge of the value of CIC care with ‘credentialed’ knowledge regarding best clinical and managerial practice. They did so in ways that were pragmatic as well as purist, reformist as well as oppositional. We argue for legitimation as negotiated practice over legitimacy as a stable state, and as labour borne by various publics as they insert themselves into matrices of knowledge production and decision-making within wider health care governance.

Psychiatrists and mental health activism during the final phase of the Franco regime and the democratic transition

In the final years of the Franco dictatorship and during the period known as the democratic transition, there were a significant number of protests in the sphere of mental health in Spain. This article analyses the origins and functioning of the Psychiatric Network, which emerged in 1971, its connection to the formation of professional organizations and its role in the reception of anti-psychiatry ideas in Spain. We reach the conclusion that, although the Network's activities took place within a left-wing political and ideological framework, and at such an important time of social change as the end of the dictatorship, its discourse and practices always demonstrated a marked professional approach.

A crisis emerges: Lesbian health between breast cancer and HIV/AIDS

In this essay, I argue that lesbians have come to be a population of concern for state-based health organizations as a result of lesbian health activism that drew connections between breast cancer and HIV/AIDS. In order to develop this analysis, I tell the story of the rise of lesbian breast cancer activism in concert with HIV/AIDS in San Francisco in the early 1990s. The state recognition of lesbian health needs, and with it the solidification of lesbian as a biopolitical category, was catalyzed by associations with the AIDS crisis and HIV activism, but also required an articulated difference, or lesbian specificity, which breast cancer provided. And yet, documenting the multiple, and potentially contradictory, ways that these associations were made resists understanding "lesbian" as a static category.

Dr. Polio: Revisiting FDR's Medical Legacy

The National Foundation for Infantile Paralysis (NFIP), the March of Dimes, and the Georgia Warm Springs Resort were reflections of Franklin D. Roosevelt's (FDR) complicated and personal relationship with polio. Between 1934 and 1957, significant advances were made in the care of polio survivors, and new and innovative medical fields gained both public attention and funding. The plight of disabled Americans and questions of accessibility also received widespread national attention. The NFIP helped establish a new prototype for grassroots philanthropy and personified FDR's vision for national health insurance. Drawing upon a variety of archival and primary sources, this article aims to revisit Roosevelt's contribution to the medical field. Rather than condone or defend FDR's public persona as a survivor of polio, this article argues that Roosevelt and his affiliated organizations played an important medical role during this period.