Search

Resumen Este artículo considera el tema de la profilaxis preexposición (PrEP), un tipo de intervención bio-médica dirigida a la prevención de la transmisión del VIH. El autor desarrolla un mapa y rastrea histórica y conceptualmente algunos de sus cursos biopolíticos como dispositivo sociotécnico en el entramado de la ciencia, la tecnología y la sociedad, además de plantear un acercamiento a la luz de las teorizaciones contemporáneas a propósito de la biomedicalización en el contexto del biocapitalismo. A manera de conclusión, el artículo muestra algunos retos que plantean los marcos que subyacen a estos nuevos abordajes del riesgo serológico, en el contexto del Estado español. Resumo Este artigo considera o tema da profilaxia pré-exposição (PrEP), um tipo de intervenção biomé-dica encaminhada à prevenção da transmissão do VIH. O autor desenvolve um mapa e rastreia histórica e conceptualmente alguns dos seus cursos biopolíticos como dispositivo sociotécnico no tecido da ciência, a tecnologia e a sociedade, além de plantear uma aproximação à luz das teori-zações contemporâneas a propósito da biomedicalização no contexto do biocapitalismo. A maneira de conclusão, o artigo mostra alguns retos que planteiam os marcos que sobejassem a estas novas abordagens do risco serológico, no contexto do Estado espanhol. Abstract This article considers the topic of pre-exposure prophylaxis (PrEP), a type of biomedical intervention aimed at preventing HIV transmission. The author develops a map and traces, historically and conceptually, some biopolitical courses of PrEP as a sociotechnical dispositive in the structural framework of science, technology, and society. In addition, it proposes an approach in the light of contemporary theorizations regarding biomedicalization in the context of biocapitalism. As a conclusion, the article shows some challenges posed by the frameworks underlying these new approaches to serological risk within the Spanish State.

Background Sweden has provided around 300 youth clinics (YCs) to address the health needs of young people since the 1970s. During the last few years, and as part of an effort to strengthen mental healthcare for young people, YCs’ role in the provision of mental healthcare has been widely debated. With such debates as background, the aim of this study is to analyse Swedish YCs’ responses to the mental (ill) healthcare needs of young people, from the perspective of national level stakeholders. Methods We used thematic analysis of interviews with eight national level stakeholders in the field of youth mental health in Sweden. Building upon the concept of biomedicalization we examined the discourses on mental (ill) health, healthcare and youth that such responses reproduce. Results YCs engage in the three simultaneous, but at times contradictory, responses of protecting, managing and bending boundaries. Remaining true to their mission as a health-promotion service compels them to protect their boundaries and limit the type of mental health issues they address. However, the perceived malfunctioning of specialized services has led them to bend these boundaries to allow in more young people with severe mental health problems. Caught between protecting and bending boundaries, the response of managing boundaries to decide who should be allowed in and who should be sent elsewhere has emerged as a middle-way response. However, it is not free from conflicts. Conclusion Building upon the concept of biomedicalization, this study poses two questions. The first relates to whether it is possible to support young people and their health without reinforcing discourses that represent young people as collectively at risk, and if so how this can be done. The second relates to the provision of mental healthcare for young people, and the need to identify conditions for integrating diagnosis and treatment within YCs, without hindering their holistic and youth-centred approach.

In recent medical events and articles the hormone testosterone has emerged as a resource for treating problems related to female sexuality. This hormone is commonly defined as the “male hormone” and presented as the “hormone of desire”. This observation led to investigate if and how the use of testosterone is found in the realm of doctors’ offices and if it is being applied as a therapeutic resource for women. This article analyzes what types of approaches and treatments have been used by doctors in a large Brazilian city. The methodology involved sought out medical professionals indicated for their specialization in treating female “sexual problems”. Considering the statements of the professionals interviewed, sexual desire is defined emphatically as the presence or absence of a greater or lesser amount of testosterone. This standard is associated to gender differences that are expressed primarily in terms of biology. Em eventos e artigos médicos recentes, nota-se o surgimento do hormônio testosterona como recurso para o tratamento de problemas relacionados à sexualidade feminina. Este hormônio é comumente definido como o “hormônio masculino” e apresentado como o “hormônio do desejo”. Esta observação levou a investigar se, e como, o uso de testosterona aparece no domínio dos consultórios médicos e se está sendo aplicado como um recurso terapêutico para as mulheres. Este artigo analisa quais tipos de abordagens e tratamentos têm sido utilizados por médicos/as em uma grande cidade brasileira. A metodologia envolveu a busca por profissionais médicos/as que foram indicados/as por sua especialização no tratamento de “problemas sexuais” femininos. Considerando as declarações dos/as profissionais entrevistados/as, o desejo sexual é definido enfaticamente pela presença ou ausência de uma quantidade maior ou menor de testosterona. Este padrão está associado a diferenças de gênero que se expressam principalmente em termos de biologia.

Depuis les années 1970, des mouvements militants internationaux dénoncent une approche médico- et techno-centrée de la naissance. En réponse à cette « techno-bio-médicalisation », le concept d’« accouchement humanisé » a émergé dans les années 1990 en Amérique latine puis s’est globalisé. Cet article propose d’analyser l’échec d’un projet japonais d’accouchement humanisé dans une maternité au Bénin. Sur la base d’observations participantes et d’entretiens, nous montrons que la proposition des actrices et acteurs du développement japonais se heurte à une forte incorporation de la « science obstétricale » par les soignant·e·s, et plus particulièrement par les sages-femmes béninoises. Plus précisément, en interdisant la présence d’un·e accompagnant·e auprès de la femme qui accouche et en refusant que celle-ci adopte une position autre que la position gynécologique, les sages-femmes reproduisent le modèle obstétrical dominant au détriment du confort et du bien-être des femmes. Since the 1970s, international activist movements have denounced a medical and techno-centric approach to birth. In response to this “techno-bio-medicalization” of birth, the concept of humanized childbirth emerged in the 1990s in Latin America and then became global. This article proposes to analyse the failure of a Japanese project of humanized childbirth in a maternity hospital in Benin. On the basis of participant observations and interviews, we show that the proposal of Japanese development actors came up against a strong incorporation of obstetrical science by the health workers and more particularly by the Beninese midwives. More specifically, by forbidding the presence of an attendant near the woman giving birth and by refusing to accept a position other than the gynaecological one, the midwives reproduce the dominant model of biomedicalization of childbirth to the detriment of women's comfort and psychological and social well-being.

Alors que le protectorat français a tenté sans succès de médicaliser l’accouchement au Cambodge à travers la création d’écoles de sages-femmes, l’ouverture de maternités et des incitations financières, des politiques de santé globale fortement relayées au début des années 2000 ont abouti à une biomédicalisation extrêmement rapide de l’accouchement au Cambodge, engendrant une rupture médicale et sociale sans précédent dans le pays. À partir d’une recherche doctorale menée entre 2013 et 2016 et mobilisant une méthodologie mixte (qualitative et quantitative), l’article montre qu’aujourd’hui, le recours à la biotechnologie est massif dans la capitale Phnom Penh. La pratique de l’épisiotomie est systématique, l’usage de la périnéorraphie (visant à resserrer le vagin des femmes) est fréquent, et les taux de césarienne augmentent rapidement, répondant à une demande construite socialement. Si cette biomédicalisation de l’accouchement a indéniablement participé à la diminution récente et spectaculaire du taux de mortalité maternelle au Cambodge, elle participe aussi à un façonnage des corps des femmes et à la construction d’un corps féminin venant répondre à des normes sociales et conjugales. While the French protectorate tried unsuccessfully to medicalize childbirth in Cambodia through the creation of midwifery schools, the opening of maternity wards and financial incentives, global health policies strongly relayed in the early 2000s led to an extremely rapid biomedicalization of childbirth in Cambodia, causing an unprecedented medical and social disruption in the country. Based on a doctoral research conducted between 2013 and 2016 and mobilizing a mixed methodology (qualitative and quantitative), the article shows that today, the use of biotechnology is massive in the capital Phnom Penh. The practice of episiotomy is systematic, the use of perineorraphy (aimed at tightening women’s vagina) is frequent, and caesarean section rates are increasing rapidly, responding to a socially constructed demand. If this biomedicalization of childbirth has undeniably contributed to the recent and spectacular decrease in the maternal mortality rate in Cambodia, it also contributes to the shaping of women’s bodies and to the construction of a female body that meets social and conjugal norms.

This dissertation examines the outbreak of depression in the United States through an ethical lens of care and disconnection. Discussions in bioethics and collaborating fields largely speak of mental health as a series of phenomena attributable to individuals, subsequently using terms like 'disease' and 'disorder' to denote abnormality in those persons affected by distress. Alternatively, I respond to the ongoing "crisis of care" through a critique of neoliberalism and biomedicalization. I argue that widespread despair is the result of a collective way of life wherein persons are detached from fundamental physical and psychosocial needs by nature of fallacious cultural commitments and techniques. I implement constructivism to empirically ground a new application of care ethics to be considered by normative ethicists. In addition to merging several established traditions such as feminist philosophy and the capabilities approach, I also contribute a comprehensive model for understanding basic needs and the distribution of caring responsibilities/roles. Further, the project enhances the field of applied bioethics by featuring a practically-specific relational approach that is built from the experiences of those embedded in daily decision-making. The dissertation critiques the theoretical soundness of psychiatric and psychological classifications and the practical efficacy of prominent solutions such as antidepressant medications and various psychotherapies. I further assert that these depictions of mental health misrepresent the experiences of those affected by depression, and thus share their stories of derealization, isolation, frustration, resentment, and hopelessness through a lens of disconnection. These feelings apply to caregivers as well: the commodification of care alongside of the constraints attached to "professionalism" are used to inhibit their autonomy, exploit their labor, and detach them from relationships with charges and other carers. This leads to issues such as moral distress, burnout, and vicarious traumatization, all of which foster despair. Finally, I respond to these collective concerns with a new framework consisting of an expanded account of fundamental needs and an analysis of "care-abilities": the capabilities one has to meet their needs and to fulfill the needs of others who depend on them. I then supplement this account with a detailed distribution of skills and responsibilities attached to the particular caring roles that one might occupy. This ethical framework is intended to be advisory and malleable to contextual practice rather than prescriptive. Doctor of Philosophy This dissertation outlines the techniques and conditions which, through persuasion or coercion, direct us towards a particular way of living marked by isolation, alienation, and precarity. This life, I argue, has facilitated an epidemic of depression and related conditions of distress in the United States. We largely consider mental health to be a series of phenomena attributable to individuals, and subsequently use terms like 'disease' and 'disorder' to denote abnormality in those persons affected by distress. Alternatively, I follow a question proposed by Johann Hari, who asks "What if depression is, in fact, a form of grief – for our own lives not being as they should? What if it is a form of grief for the connections we have lost, yet still need?" The dissertation critiques the paradigms of neoliberalism, which refers to the ideology of elevating market theories to state-sponsored and enforced norms, and biomedicalization, an affiliated logic which individualizes and medicalizes all human problems. In response, I develop an ethics of care framework that prioritizes relationships, acknowledges our shared dependencies, and fosters skills for quality care and advocacy. By viewing depression as an affective reaction to social dysfunction, my analysis also challenges conventional interpretations regarding mental health and illness. This project critiques the theoretical and empirical efficacy of modern mental health solutions, details the various challenges and harms experienced by both depressed persons and particular caregivers, and outlines an alternative ethical approach to be used for evaluation and subsequent care.

Resumen Introducción: aunque en la última década el concepto de biomedicalización ha sido relevante en América Latina para entender algunos procesos mediante los cuales la biomedicina participa en la constitución de sujetos y sus padecimientos, poco se ha explorado su relación con la conformación de la sexualidad. Desarrollo: el objetivo de este texto es analizar, desde una perspectiva sociológico-feminista, la biomedicalización del riesgo sexual al virus de inmunodeficiencia humana, mediante la profilaxis preexposición, y al virus del papiloma humano, mediante la aplicación de la vacuna de prevención en México, Colombia y Brasil. Primero, se presenta la noción de biomedicalización, sus usos teóricos en la sociología y los estudios de la ciencia, la tecnología y la biomedicina. Posteriormente, se abordan algunos textos que analizan algunas vicisitudes de la biomedicalización del riesgo sexual, mediante estas biotecnologías en los países mencionados. Finalmente, se problematizan algunas de las ventajas y retos teóricos del uso del concepto de biomedicalización en diversos contextos de América Latina y se señala cuál es su relevancia para comprender las relaciones y diferencias de género en la región. Conclusiones: en estos días, con el auge de la biomedicina y de las farmacéuticas transnacionales, se hace necesario analizar las implicaciones históricas, sociales y políticas de la biomedicalización de la sexualidad en contextos poscoloniales como el latinoamericano. Abstract Introduction: In the last decade, the concept of "biomedicalization" has played a relevant role in Latin American Science, Technology, and Biomedicine (STS) studies amidst sociological and academic debates on the implications of biomedical interventions in the production of subjects and diseases. However, its relationship with sexuality has scarcely been evaluated. Development: This article aimed to analyze how sexual risk to avoid acquiring both human immunodeficiency virus through PrEP implementation and human papilloma virus through the preventive vaccine implementation in Mexico, Colombia, and Brazil has been thoroughly biomedicalized, from a sociological feminist perspective. First, the concept of biomedicalization and its theoretical uses in medical sociology and STS are briefly introduced. Then, few relevant texts are discussed that approach some aspects concerning the increase in biomedicalization of sexual risk within these biotechnologies in the three countries. Finally, we analyzed the advantages and challenges of introducing the concept of biomedicalization in the Latin American context and its relevance in terms of understanding sex-related relationships and differences. Conclusions: With the recent development of the biomedicine and transnational pharmaceutical industry, it is necessary to analyze the historical, social, and political implications of the biomedicalization of sexuality in the postcolonial contexts, such as those found in Latin America. Resumo Introdução: ainda que na última década o conceito de biomedicalização tem sido relevante na América Latina para entender alguns processos mediante os quais a biomedicina participa na constituição de sujeitos e seus padecimentos, sua relação com a conformação da sexualidade tem sido pouco explorada. Desenvolvimento: o objetivo deste texto é analisar, desde uma perspectiva sociológico-feminista, a bio-medicalização do risco sexual ao vírus da imunodeficiência humana (VIH) mediante a Profilaxia pre-ex-posição (PrEP, por suas siglas em inglês), e ao vírus do papiloma humano (VPH) mediante a aplicação da vacuna de prevenção no México, na Colômbia, e no Brasil. Primeiro, se apresenta a noção de biomedi-calização, seus usos teóricos na sociologia e os STS (estudos da ciência, a tecnologia e a biomedicina, por suas siglas em inglês). Posteriormente se abordam alguns textos que analisam algumas variabilidades da biomedicalização do risco sexual, mediante estas biotecnologias nos países mencionados. Finalmente, se problematizam algumas das vantagens e desafios teóricos do uso do conceito de biomedicalização em diversos contextos da América Latina e se assinala qual é sua relevância para compreender as relações e diferenças de gênero na região. Conclusões: em nossos dias, com o auge da biomedicina e das farmacêuticas transacionais, se faz necessário analisar as implicações históricas, sociais e políticas da biomedicalização da sexualidade em contextos pós-coloniais, como o Latino-Americano.

L’introduction d’innovations en Médecine Chinoise Traditionnelle (zhongyi, MCT) et l’influence de la médecine des preuves (evidence-based medicine, EBM) comme modèle de validation scientifique et voie de légitimation avec un recours aux essais cliniques qui se systématise sont révélateurs du processus de biomédicalisation de la recherche à l’œuvre aujourd’hui. La MCT est la forme standardisée de médecine chinoise intégrée au système de santé publique promue par le gouvernement chinois depuis les années 1950. Trois points seront discutés dans cet article : le premier introduit le contexte médical « pluriel » de la Chine contemporaine et évoque un débat récent sur l’intégration de la MCT dans le système de santé publique, qui a mobilisé des acteurs officiels, des intellectuels et la population générale. Le deuxième offre un éclairage sur la recherche et le développement à partir de l’exemple de la recherche médicale sur le sida en MCT en Chine. Le dernier point porte sur les interfaces de savoirs thérapeutiques hybrides et leur mobilisation dans le cadre de la recherche en MCT et de la construction d’espaces de soins mondialisés. The issue of innovations in TCM (zhongyi) – the Chinese medicine integrated in the public health system promoted by the post-1949 Chinese government, is approached through the case-study of the ongoing biomedicalisation of TCM research and the use of ‘evidence-based medicine’ (EBM) through clinical trials. Three points will be discussed: the first introduces a ‘plural’ medical context and a recent debate in China on the issue of pulling-out TCM from the public health‑care system involving official actors, population at large and the academics. The second focuses on aspects of research and development through the case-study of AIDS-related TCM research in China today. The last point discusses the biomedicalisation of research in TCM and its conceptualisation as CAM in a context of TCM fast-track globalisation. Therefore, such discussion raises the broad issue of the interfaces and cultural politics of knowledge. La introducción de innovaciones en la Medicina China Tradicional (zhongyi, MCT) y la influencia de la medicina de pruebas (evidence-based medicine - EBM) como modelo de validación científica y de legitimación con recurso a las pruebas clínicas sistematicas, revelan un proceso de biomedicalización de la investigacion científica en esta área. La MCT es una forma estandard de medicina china integrada en el sistema de salud publica promocionado por el gobierno de China desde los anos 1950. Tres aspectos se discuten en el presente artículo: el primero es la introducción en el contexto medico plural actual de un debate sobre la integración de la MCT en el sistema de salud pública. Este debate ha mobilizado actores oficiales, intelectuales, y la población en general. El segundo punto es dar una perspectiva sobre la investigación y desarrollo en MCT con el caso de la investigación medica sobre el SIDA. El último punto trata de la biomedicalización de la MCT y su conceptualización como CAM en un proceso de globalización muy rápido de la MCT. Se tratan así temas más generales como son el rol de los interfaces de los conocimientos terapéuticos híbridos y de la construcción de espacios terapéuticos globalizados.

International audience; The experience of childbirth has been technologized worldwide, leading to major social changes. In France, childbirth occurs almost exclusively in hospitals. Few studies have been published on the opinions of French women regarding obstetric technology and, in particular, caesarean section. In 2017–2018, we used a mixed methods approach to determine French women's preferences regarding the mode of delivery, and captured their experiences and satisfaction in relation to childbirth in two maternity settings. Of 284 pregnant women, 277 (97.5%) expressed a preference for vaginal birth, while seven (2.5%) women expressed a preference for caesarean section. Vaginal birth was also preferred among 26 women who underwent an in-depth interview. Vaginal birth was perceived as more natural, less risky and less painful, and to favour mother–child bonding. This vision was shared by caregivers. The women who expressed a preference for vaginal birth tended to remain sexually active late in their pregnancy, to find sexual intercourse pleasurable, and to believe that vaginal birth would not enlarge their vagina. A large majority (94.5%) of women who gave birth vaginally were satisfied with their childbirth experience, compared with 24.3% of those who underwent caesarean section. The caring attitude of the caregivers contributed to increasing this satisfaction. The notion of women's ‘empowerment’ emerged spontaneously in women's discourse in this research: women who gave birth vaginally felt satisfied and empowered. The vision shared by caregivers and women that vaginal birth is a natural process contributes to the stability of caesarean section rates in France.

Neste artigo temos como objetivo caracterizar uma configuração em torno da percepção da fertilidade e descrever sua articulação ao aparato de gênero e à biomedicalização. Com uma abordagem etnográfica, tomamos como ponto de partida um grupo no Facebook sobre percepção da fertilidade e realizamos entrevistas semiestruturadas com seis de suas porta-vozes. Além disso, analisamos livros e sítios que nos foram indicados nessas entrevistas e fizemos observação participante em um curso presencial ministrado por uma das interlocutoras. Concluímos que concomitante a projetos coletivos de empoderamento de corpos e subjetividades com ciclos menstruais, há responsabilização individual pela saúde e pelo autoaprimoramento. Ademais, reforça-se a substancialização do binarismo sexual com a produção de uma “natureza hormonal”, ainda que seja mais associada à saúde que ao gênero. The article aims to characterize fertility awareness and describe its articulation with the gender apparatus and biomedicalization. With an ethnographic approach, we took a group on Facebook as a starting point and conducted semi-structured interviews with six of its spokespersons. In addition, we analyzed books and sites recommended in these interviews and made participant observation in a face-to-face course given by one of the interlocutors. We conclude that fertility awareness practices are related to collective projects for empowering bodies and subjectivities with menstrual cycles and at the same time to individual responsibilisation for health and self-improvement. Furthermore, it reinforces the substantialization of sexual binarism with the production of a “hormonal nature”, although it is linked to health instead of gender.

UIDB/04038/2020 UIDP/04038/2020 The quantification of bodies serves an ambivalent purpose. On the one hand, it includes individuals in a new biopolitical norm, making them co-producers of the new biomedicine’s arrangements; on the other, it urges them to explore the deepest natural norms, making them protagonists in the production of what Donna Haraway (2003) called naturecultures. By recording, monitoring, and supplying large amounts of biometric data, individuals willl gradually be included in the process of incorporating a new ethos, characterized by locating them in a new level of citizenship in which the techniques of the self are overlapped by the technologies of corporeality. The purpose of this article is to reflect on the paths of social and individual transformations that have in the quantification of bodies its fundamental extracting method of the raw materials used to build an imagined future in which individuals are fully enlightened and informed and systems are fully efficient. publishersversion published

Levando em consideração que a segurança das pílulas anticoncepcionais voltou a ser alvo de controvérsias nos anos 2010, este trabalho teve como objetivo descrever como a ginecologia brasileira tem se posicionado nesse quadro. Tomando a Federação Brasileira das Associações de Ginecologia e Obstetrícia (Febrasgo) como ponto de partida, foram realizadas entrevistas semiestruturadas com especialistas em contracepção, observações participantes em congressos nacionais e regionais de ginecologia, além de acompanhamento de notícias sobre contracepção na imprensa, em sites de associações médicas e da Agência Nacional de Vigilância Sanitária (Anvisa). Dentre as conclusões, observou-se que as práticas da ginecologia hegemônica têm enfatizado os benefícios e minimizado os riscos das pílulas, contribuindo para a produção e reiteração da segurança do dispositivo. Também são descritas as consequências que tais práticas têm na atualização do aparato de gênero, saúde, risco, aprimoramento e biomedicalização. Considering that the safety of contraceptive pills was once again the subject of controversy in the 2010s, this study aimed to describe where Brazilian gynecology has stood in this context. Taking the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo) as a starting point, semi-structured interviews with specialists in contraception were conducted, participant observation was carried out at national and regional congresses of gynecology, in addition to keeping up to date with news about contraception in the press, and on websites of medical associations and of the National Health Surveillance Agency (Anvisa). Among the conclusions, it was observed that the practices of hegemonic gynecology have emphasized the benefits and minimized the risks of the pills, contributing to the production and reiteration of the safety of the device. The consequences that such practices have in the updating of the gender, health, risk, enhancement, and biomedicalization apparatus are also described.

International audience; Background: Women's empowerment, and maternal and neonatal health are important targets of the Sustainable Development Goals. Our objective is to examine the relationship between women's empowerment and elective cesarean section (ECS), focusing on Vietnam, a country where the use of CS has increased rapidly in recent decades, which raises public health concerns.Methods: We hypothesized that in the context of the developing biomedicalization of childbirth, women's empowerment increases the use of ECS due to a woman's enhanced ability to decide her mode of delivery. By using microdata from the 2013-2014 Multiple Indicator Clusters Survey, we conducted a multivariate analysis of the correlates of ECS. We studied a representative sample of 1343 institutional single birth deliveries. Due to higher ECS rates among multiparous (18.4%) than primiparous women (10.1%) and the potential interaction between parity and other correlates, we used separate models for primiparous and multiparous women.Results: Among the indicators of women's external resources, which include a higher level of education, having worked during the previous 12 months, and having one's own mobile phone, only education differed between primiparous and multiparous women, with a higher level among primiparous women. Among primiparous women, no resource indicator was significantly linked to ECS. However, considering women's empowerment facilitated the identification of the negative impact of having had fewer than 3 antenatal care visits on the use of ECS. Among multiparous women, disapproval of intimate partner violence (IPV) was associated with a doubled likelihood of undergoing ECS (odds ratio = 2.415), and living in an urban area also doubled the likelihood of ECS. The positive association with living in the richest household quintile was no longer significant when attitude towards IPV was included in the model. In both groups, being aged 35 or older increased the likelihood of undergoing ECS, and this impact was stronger in primiparous women.Conclusions: These results underline the multidimensionality of empowerment, its links to other correlates and its contribution to clarifying the influence of these correlates, particularly for distinguishing between medical and sociocultural determinants. The results advocate for the integration of women's empowerment into policies aimed at reducing ECS rates.

Human reproduction is increasingly commodified, which paves the way for reproductive enhancement rather than just assistance. Non-medical gender/sex selection is one of the reproductive enhancement services that is offered on the fertility market, and it is a practice that raises severe concerns regarding the social and political impact of biotechnologies. Through Critical Discourse Analysis and Biomedicalization theory, I analyse how non-medical gender/sex selection is legitimised in online forum discussions. I argue that gender/sex selection is legitimized through gender- and family-conservative and neoliberal ideologies, and that gender/sex selection can be understood as a tool to enhance the family, increase privilege, and attain hypernormativity.

Resumo Este ensaio aborda a importância da descolonização da saúde, fundamentada no referencial teórico das epistemologias do Sul de Boaventura de Sousa Santos, e aponta para uma ecologia de cuidados a ser produzida no campo da saúde coletiva, abordando saúde e doença, sofrimento e cura, agravo e cuidado por formas de luta que emergem no enfrentamento das dinâmicas capitalista, colonialista e patriarcal. O processo de biomedicalização tem se produzido na emergência de uma monocultura de concepções dominantes do saber biomédico que define as condições de validade do conhecimento e das intervenções sobre saúde, doença, cuidado e cura. Esta análise aponta para a importância de pesquisas colaborativas e não extrativistas que partem do reconhecimento dessa diversidade de saberes, práticas e experiências, da sua copresença e dos seus encontros, das lutas pela justiça social e cognitiva e das múltiplas e diversificadas lutas pelo acesso à saúde e aos cuidados de saúde. As relações entre a saúde coletiva e os saberes e práticas do cuidado e da cura que fazem parte da experiência e do mundo dos povos indígenas aparecem como um exemplo importante para o aprendizado de um pensamento e de um agir ecológico em saúde. Abstract This essay focuses on the importance of decolonizing health care, based on the theoretical framework of the epistemologies of the South proposed by Boaventura de Sousa Santos, and points to an ecology of care to be produced in the field of public healthcare, approaching health and illness, suffering and healing, disorder and care through struggles that emerge in facing capitalist, colonialist and patriarchal dynamics. The process of biomedicalization emerges within a monoculture of dominant conceptions of biomedical knowledge that define the terms of validity of knowledge and interventions on health, illness, care and healing. This analysis points to the importance of collaborative and non-extractivist research projects based on the recognition of the diversity of knowledges, practices and experiences, of their copresence and their encounters, of the struggles for social and cognitive justice and of the multiple and diverse struggles for health and access to medical care. The relations between collective health and the knowledge, care, and healing practices that are part of the experience and of the world of the indigenous peoples emerge as an important example of how to learn to think and act ecologically in the field of health.

In 2014, Denmark abolished the castration requirement that had been in place since the 1950s in order to obtain legal gender reassignment. As a self-declaration model was introduced, the law was amended to enable everyone with a uterus to retain access to pregnancy care and assisted reproduction. Combining Science and Technology Studies with critical transgender scholarship, this paper explores how the legal reforms, which sought to separate legal gender status from the healthcare system, have shaped the emergence of reproductive transmasculinities and the institutionalization of reproductive citizenship for trans men. Drawing on the concept of sociotechnical imaginaries (­Jasanoff, 2015), I discuss how specific understandings of coherence between bodies, gender and parenthood organize and restrict the reproductive practices of trans men. For example, men who give birth are still registered as mothers. Through the framework of biomedicalization (Clarke et al., 2010), I extend my discussion of reproductive autonomy to fertility preservation access. I discuss why, in Denmark, sperm can be frozen in relation to gender- affirmative treatment, but eggs cannot, and in doing so I highlight how this disparity is not only shaped by normative practices of risk prediction, but also by the political opposition to surrogacy in Denmark.

Cette thèse procède, depuis une perspective issue des études culturelles, à une exploration critique et située (Haraway, 1988) de la culture alimentaire québécoise contemporaine et des définitions variables de la « saine » alimentation qu’elle concourt à produire et à rendre effective. Plus précisément, j’analyse les rapports de pouvoir qui l’informent et prennent forme et effectivité à travers les savoirs et pratiques constitutives de la saine alimentation (dans ses multiples formes et modes d’existence). À travers l’analyse critique de la culture alimentaire québécoise contemporaine, je questionne les corps, humains comme plus-qu’humains, qui s’y retrouvent « produits » et différenciés par des rapports de pouvoir inégaux. L’analyse présentée résulte d’une ethnographie dialogique incorporée suivant les méthodes de collecte des matériaux et d’analyses proposées par Probyn (2016). La thèse est découpée en trois parties distinctes, mais interreliées. La première explore la culture alimentaire québécoise au cœur de laquelle je m’inscris. Elle permet à la fois la présentation de ladite culture et des savoirs, pratiques, événements qu’elle concourt à mettre en forme, mais également la multiplicité des définitions de la saine alimentation qui y émergent, en fonction de ses différents contextes d’émergence. Tout au long de cette partie, je mets en évidence comment sont produits, articulés et légitimés certains savoirs tout autant que comment sont mises en forme et en cause certaines des relations impliquant et liant humains et plus-qu’humains, et qui participent des multiples modes d’émergence de la saine alimentation, au Québec. Au sein de la culture alimentaire contemporaine, l’alimentation saine est régulièrement réfléchie et problématisée dans son rapport aux corps humains. La deuxième partie de la thèse présente mon analyse de ce que j’ai appelé la culture alimentaire biomédicalisée, et tout particulièrement des relations entre les corps, l’alimentation et la santé qu’elle concourt à produire. J’y mets en évidence comment la culture alimentaire contemporaine ne peut être réfléchie sans considération pour les discours healthists (Crawford, 1980) contemporains, qui informent les manières par lesquelles les corps sont mis en relation avec l’alimentation, à l’aulne de considérations pour la santé. J’y mobilise les outils conceptuels proposés par Clarke et al. (2010) sur la biomédicalisation du champ social pour questionner comment l’alimentation et les corps sont mis en relation dans un contexte où la santé est un objectif moral et individuel à atteindre (Crawford, 1980; Lupton, 1997; Metzl et Kirkland, 2010). J’y critique comment la culture alimentaire biomédicalisée limite le type de relations qui peuvent prendre forme et être considérées entre l’alimentation et les corps, tout autant que les types de corps qui y sont produits et autorisés. La troisième partie de la thèse s’intéresse aux corps, humains comme plus-qu’humains, qui sont produits au sein de la culture alimentaire biomédicalisée tout autant qu’aux rapports de pouvoir qui participent de leur production - différenciée. Par « produire », j’entends notamment comment des corps se retrouvent discursivement définis, encadrés, contrôlés, etc.; évalués, caractérisés, discriminés, exclus, stigmatisés; matériellement produits (leurs matérialités corporelles, leur biologie, etc.). Je navigue ainsi entre différentes manières d’analyser leur production tout autant qu’entre différents types de corps qui y sont produits, à partir de réflexions (et de littératures) qui les posent et les questionnent depuis des épistémologies variées., This PhD thesis presents, from a cultural studies perspective, a critical and situated (Haraway, 1988) exploration of Quebec’s contemporary food culture and of the various definitions of “healthy” food it produces and renders effective. More precisely, I analyse the power relationships that inform its development as well as those taking form and effectivity through the knowledge and practices constitutive of healthy food (and its multiple forms and modes of existence). Through critical analysis of the current Quebec food culture, I question the bodies, human and more-than-human ones, that are produced therein, and are differentiated by unequal power relationships. The analysis presented is the result of an embodied and dialogic ethnography following the methods of materials gathering and analysis suggested by Probyn (2016). The thesis is separated into three distinct, but interrelated, parts. The first part explores Quebec’s food culture, in which I am fully immersed. This part presents the food culture and the knowledge, practices, and events that it contributes to creating, as well as the multiplicity of healthy food definitions that emerge within it, according to their various contexts of emergence. Throughout this part, I highlight how particular kinds of knowledge are produced, articulated and legitimated, as well as how relationships involving and linking humans and more-than-humans are produced and conveyed. I demonstrate how all of these processes participate in the multiple modes of emergence of healthy food in Quebec. In the current food culture, healthy food is regularly thought and problematized in relationship to human bodies. The second part of the thesis presents my analysis of what I have called the biomedicalized food culture, attending especially to the relationships between bodies, food, and health it contributes to creating. I put at the forefront how the current food culture cannot be analysed without taking into account the contemporary “healthist” (Crawford, 1980) discourses that inform the manners by which bodies are put in relation to food, under health-oriented considerations. I mobilize the conceptual tools proposed by Clarke et al. (2010) on the biomedicalization of the social field to question how food and bodies are put in relation and problematized, in a context where health is a moral and individual objective to reach (Crawford, 1980; Lupton, 1997; Metzl et Kirkland, 2010). I criticize how the biomedicalized food culture limits the type of relationships that can take form and be considered between food and bodies, as well as the types of bodies that are produced and authorized. The third part of the thesis is concerned with the bodies, human and more-than-human ones, that are produced within the biomedicalized food culture, as much as by the power relationships that participate in their production and differentiation. By “produce”, I mean among other things how bodies are discursively defined, framed, controlled, etc.; evaluated, characterized, discriminated, excluded, stigmatized; materially produced (their corporeal materialities, their biology, etc.). I navigate between different manners of analysing their production as much as I explore the different types of bodies that are produced, drawing on reflections (and literatures) that apprehend and question them from various epistemologies.

Resumo Este ensaio aborda a importância da descolonização da saúde, fundamentada no referencial teórico das epistemologias do Sul de Boaventura de Sousa Santos, e aponta para uma ecologia de cuidados a ser produzida no campo da saúde coletiva, abordando saúde e doença, sofrimento e cura, agravo e cuidado por formas de luta que emergem no enfrentamento das dinâmicas capitalista, colonialista e patriarcal. O processo de biomedicalização tem se produzido na emergência de uma monocultura de concepções dominantes do saber biomédico que define as condições de validade do conhecimento e das intervenções sobre saúde, doença, cuidado e cura. Esta análise aponta para a importância de pesquisas colaborativas e não extrativistas que partem do reconhecimento dessa diversidade de saberes, práticas e experiências, da sua copresença e dos seus encontros, das lutas pela justiça social e cognitiva e das múltiplas e diversificadas lutas pelo acesso à saúde e aos cuidados de saúde. As relações entre a saúde coletiva e os saberes e práticas do cuidado e da cura que fazem parte da experiência e do mundo dos povos indígenas aparecem como um exemplo importante para o aprendizado de um pensamento e de um agir ecológico em saúde.

[EN] Background: Opioids are one of the most prescribed treatments for chronic pain (CP). However, their long-term use (>3 months) has been surrounded by controversy, due to loss of beneficial effects. Objective: To explore the experiences of people with chronic non-malignant low back pain in Spain undergoing long-term treatment with opioids. Design: Qualitative study. Setting and participants: We conducted 15 semi-structured interviews at the Pain Clinic with persons taking opioid treatment. Methods: The interviews were analysed by qualitative content analysis as described by Graneheim and Lundman, and developed categories and themes discussed in light of a biomedicalization framework. Main results: We developed one overarching theme—Living with opioids: dependence and autonomy while seeking relief—and three categories: The long pathway to opioids due to the invisibility of pain; Opioids: from blind date to a long-term relationship; and What opioids cannot fix. Discussion: The long and difficult road to find effective treatments was a fundamental part of coping with pain, involving long-term relationships with the health system. This study reflects the benefits, and drawbacks of opioids, along with struggles to maintain autonomy and make decisions while undergoing long-term treatment with opioids. The paper also highlights the consequences of pain in the economy, family and social life of patients. Conclusions: Patients' experiences should be considered to a greater extent by health-care professionals when giving information about opioids and setting treatment goals. Greater consideration of the social determinants of health that affect CP experiences might lead to more effective solutions to CP. We would like to thank the participants of this study for generously sharing their experiences. We would also want to thank the physicians and nurses from the Unit of Pain in the University Hospital ‘Puerta del Mar’ for letting us be part of their team for a period of time, especially Dr José Manuel Trinidad. Helena De Sola has disclosed that she has received a grant for researching in the field of Pain from Fundación Española del Dolor

Se analiza la incidencia del diagnóstico de Trastorno del Espectro Autista (TEA) sobre la percepción y organización del tiempo en la vida cotidiana, de parte de las familias, y en especial las madres de niños y niñas diagnosticados por TEA (NNDxTEA). Los resultados surgen de dos investigaciones de posgrado. La metodología es cualitativa, reconstruye las historias de vida de cuatro madres que durante 2015 acompañaron a sus NNDxTEA a un Centro Terapéutico en la Provincia de Buenos Aires, Argentina. Se consideran dos líneas. Primera, la medicalización y biomedicalización como procesos de anillados concéntricos en tres niveles: macro, meso y micro, profundizando el análisis en este último. Segunda, la vinculación entre los procesos de diagnóstico y tratamiento en salud mental, y las biosocialidades. Adicionalmente se incorporan consideraciones desde la sociología del tiempo. Los resultados exponen la incidencia del diagnóstico de TEA sobre el tiempo en cuatro ejes: la transformación de las actividades cotidianas, por la asistencia a espacios terapéuticos; las expectativas respecto del tiempo libre y esparcimiento; los cambios que, de haber podido, hubieran hecho en el tiempo que los NNDxTEA llevan realizando las terapias; y las creencias y pensamientos acerca del futuro del NNDxTEA de parte de sus familiares. The influence of the Autistic Spectrum Disorder (ASD) diagnosis on the perception and organization of time in daily life by families, especially mothers, of children diagnosed with ASD is analyzed. Results stem from two graduate investigations. The methodology is qualitative, reconstructing the life stories of four mothers who, throughout 2015, accompanied their children diagnosed with ASD to a Therapeutic Center in the Province of Buenos Aires, Argentina. Two lines are considered: first, the medicalization and biomedicalization as concentric ringed processes in three levels: macro, meso and micro, deepening the analysis in the latter. Second, the link between diagnostic and treatment processes in mental health and the biosocialities. Some considerations on sociology of time are also incorporated. The results show the incidence of the ASD diagnosis over time, in four areas: the transformation of daily activities, by attending therapeutic spaces; the expectations regarding free time and leisure; the changes that, if possible, have been made in the time the children diagnosed with ASD have been carrying out the therapy; and the beliefs and thoughts of their relatives about the future of the children diagnosed with ASD.

En el artículo se analiza el despliegue actual de procesos de medicalización y biomedicalización de la sociedad y las estrategias biopolíticas de gobierno de la vida considerada como continuo vital. El objetivo es describir y analizar algunos mecanismos en relación con la infancia y el envejecimiento, tomando en cuenta las nociones de riesgo y mejoramiento, concebidas ambas como tecnologías de la vida. Como resultado del cruce de las genealogías de los procesos de medicalización y gobierno de la infancia y del envejecimiento, hallamos que en ambos procesos actúa una lógica anticipatoria del riesgo y una búsqueda de mejoramiento de la salud y la vida, con dos vectores que operan coincidentemente: la epidemiologización de la vida y la presentificación vital de riesgos futuros. Las conclusiones permiten reflexionar sobre formas de normalización orientadas a mecanismos de prevención de riesgos o efectos potenciales a futuro The aim of the article is to describe and analyze some mechanisms related to childhood and aging, taking into account the notions of risk and improvement, both conceived as technologies of life. In order to do so, it systematizes and presents different theoretical features of medicalization, biomedicalization and politics of life’s perspectives, attending to the relevance and nuances of technologies within those perspectives. As a result of the crossing of the genealogies of the processes of medicalization and governance of childhood and of aging, we find that in both processes there is an anticipatory logic of risk and a search for improvement of health and life, with two vectors that operate coincidentally: the epidemiologization of life and the vital identification of future risks. The results allow to reflecting on forms of normalization oriented to mechanisms of prevention of risks or potential future effects. Fil: Bianchi, Eugenia. Universidad de Buenos Aires. Facultad de Ciencias Sociales. Instituto de Investigaciones "Gino Germani"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Rodríguez Zoya, Paula Gabriela. Universidad de Buenos Aires. Facultad de Ciencias Sociales. Instituto de Investigaciones "Gino Germani"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina

Implantable smart heart devices (ISHDs), such as pacemakers or ICDs, are technologies used to support cardiac function, with medical information leaflets promising low impact and a higher quality of life. Yet, previous studies have shown that these devices do not only enhance hearts, but that the intimidate relationship between devices and bodies creates ‘everyday cyborgs’, whose hybrid bodies bring new complexities, vulnerabilities and interconnectivities. As carriers of ISHDs need to negotiate safe spaces and care for both bodies and devices in their daily lives, there is a need for studies on the ‘mundane’ practices and strategies of resilience of carriers. This study aims to explore how carriers of ISHDs learn to live with their devices, whilst their devices are learning to live with them. The research consisted of ten in-depth interviews with Dutch carriers of ISHDs in which these themes were explored. It shows how carriers of ISHDs manage complexities by framing their experience into a ‘narrative of uniqueness’, in which they explained that their case was unlike any other, which allowed and empowered them to 1) gain extensive knowledge on their bodies, devices and illness, which can be used to 2) challenge their doctors and manufactures and 3) negotiate safe spaces for their hybrid bodies.

In a world tainted by the cult of perfect health and the biomedicalization of identity, the value attributed to individual life appears to come increasingly from individuals’ capacity to maintain— and even enhance—their biological “capital.” The valorization of “life itself” in the bioeconomy fosters a representation of the body as capital. Stemming from the notion of human capital developed by Gary Becker, the conception of the body as capital is dissociable from the bioeconomy, the ultimate stage of globalized capitalism. Not only does the bioeconomy model dictate all neoliberal politics in innovation and research implemented since the early 1980s, it is redefining the very foundations of citizenship. Maintaining and extending health is therefore seen as an investment that increases individuals’ social “value.” This concept of the body as capital is evident in the development of private umbilical cord blood stem cell banks that encourage parents to invest in their children’s biological capital. It also shows up in the phenomenon of medical tourism. This article presents a theoretical analysis of the concept of body capital via two phenomena: the development of private cord blood banks, medical tourism, and translational medicine.In a world tainted by the cult of perfect health and the biomedicalization of identity, the value attributed to individual life appears to come increasingly from individuals’ capacity to maintain— and even enhance—their biological “capital.” The valorization of “life itself” in the bioeconomy fosters a representation of the body as capital. Stemming from the notion of human capital developed by Gary Becker, the conception of the body as capital is dissociable from the bioeconomy, the ultimate stage of globalized capitalism. Not only does the bioeconomy model dictate all neoliberal politics in innovation and research implemented since the early 1980s, it is redefining the very foundations of citizenship. Maintaining and extending health is therefore seen as an investment that increases individuals’ social “value.” This concept of the body as capital is evident in the development of private umbilical cord blood stem cell banks that encourage parents to invest in their children’s biological capital. It also shows up in the phenomenon of medical tourism. This article presents a theoretical analysis of the concept of body capital via two phenomena: the development of private cord blood banks, medical tourism, and translational medicine.In a world tainted by the cult of perfect health and the biomedicalization of identity, the value attributed to individual life appears to come increasingly from individuals’ capacity to maintain— and even enhance—their biological “capital.” The valorization of “life itself” in the bioeconomy fosters a representation of the body as capital. Stemming from the notion of human capital developed by Gary Becker, the conception of the body as capital is dissociable from the bioeconomy, the ultimate stage of globalized capitalism. Not only does the bioeconomy model dictate all neoliberal politics in innovation and research implemented since the early 1980s, it is redefining the very foundations of citizenship. Maintaining and extending health is therefore seen as an investment that increases individuals’ social “value.” This concept of the body as capital is evident in the development of private umbilical cord blood stem cell banks that encourage parents to invest in their children’s biological capital. It also shows up in the phenomenon of medical tourism. This article presents a theoretical analysis of the concept of body capital via two phenomena: the development of private cord blood banks, medical tourism, and translational medicine.

Implantable smart heart devices (ISHDs), such as pacemakers or ICDs, are technologies used to support cardiac function, with medical information leaflets promising low impact and a higher quality of life. Yet, previous studies have shown that these devices do not only enhance hearts, but that the intimidate relationship between devices and bodies creates ‘everyday cyborgs’, whose hybrid bodies bring new complexities, vulnerabilities and interconnectivities. As carriers of ISHDs need to negotiate safe spaces and care for both bodies and devices in their daily lives, there is a need for studies on the ‘mundane’ practices and strategies of resilience of carriers. This study aims to explore how carriers of ISHDs learn to live with their devices, whilst their devices are learning to live with them. The research consisted of ten in-depth interviews with Dutch carriers of ISHDs in which these themes were explored. It shows how carriers of ISHDs manage complexities by framing their experience into a ‘narrative of uniqueness’, in which they explained that their case was unlike any other, which allowed and empowered them to 1) gain extensive knowledge on their bodies, devices and illness, which can be used to 2) challenge their doctors and manufactures and 3) negotiate safe spaces for their hybrid bodies.

El objetivo del artículo es describir y analizar algunos mecanismos en relación con la infancia y el envejecimiento, tomando en cuenta las nociones de riesgo y mejoramiento, concebidas ambas como tecnologías de la vida. Para ello sistematiza y expone distintas aristas teóricas de los enfoques de la medicalización, biomedicalización y políticas de la vida, atendiendo a la relevancia y matices que adquieren las tecnologías en tales enfoques. Como resultado del cruce de las genealogías de los procesos de medicalización y gobierno de la infancia y del envejecimiento, hallamos que en ambos procesos actúa una lógica anticipatoria del riesgo y una búsqueda de mejoramiento de la salud y la vida, con dos vectores que operan coincidentemente: la epidemiologización de la vida y la presentificación vital de riesgos futuros. Los resultados permiten reflexionar sobre formas de normalización orientadas a mecanismos de prevención de riesgos o efectos potenciales a futuro., The aim of the article is to describe and analyze some mechanisms related to childhood and aging, taking into account the notions of risk and improvement, both conceived as technologies of life. In order to do so, it systematizes and presents different theoretical features of medicalization, biomedicalization and politics of life’s perspectives, attending to the relevance and nuances of technologies within those perspectives. As a result of the crossing of the genealogies of the processes of medicalization and governance of childhood and of aging, we find that in both processes there is an anticipatory logic of risk and a search for improvement of health and life, with two vectors that operate coincidentally: the epidemiologization of life and the vital identification of future risks. The results allow to reflecting on forms of normalization oriented to mechanisms of prevention of risks or potential future effects.

Se analiza la incidencia del diagnóstico de Trastorno del Espectro Autista (TEA) sobre la percepción y organización del tiempo en la vida cotidiana, de parte de las familias, y en especial las madres de niños y niñas diagnosticados por TEA (NNDxTEA). Los resultados surgen de dos investigaciones de posgrado. La metodología es cualitativa, reconstruye las historias de vida de cuatro madres que durante 2015 acompañaron a sus NNDxTEA a un Centro Terapéutico en la Provincia de Buenos Aires, Argentina. Se consideran dos líneas. Primera, la medicalización y biomedicalización como procesos de anillados concéntricos en tres niveles: macro, meso y micro, profundizando el análisis en este último. Segunda, la vinculación entre los procesos de diagnóstico y tratamiento en salud mental, y las biosocialidades. Adicionalmente se incorporan consideraciones desde la sociología del tiempo. Los resultados exponen la incidencia del diagnóstico de TEA sobre el tiempo en cuatro ejes: la transformación de las actividades cotidianas, por la asistencia a espacios terapéuticos; las expectativas respecto del tiempo libre y esparcimiento; los cambios que, de haber podido, hubieran hecho en el tiempo que los NNDxTEA llevan realizando las terapias; y las creencias y pensamientos acerca del futuro del NNDxTEA de parte de sus familiares. The influence of the Autistic Spectrum Disorder (ASD) diagnosis on the perception and organization of time in daily life by families, especially mothers, of children diagnosed with ASD is analyzed. Results stem from two graduate investigations. The methodology is qualitative, reconstructing the life stories of four mothers who, throughout 2015, accompanied their children diagnosed with ASD to a Therapeutic Center in the Province of Buenos Aires, Argentina. Two lines are considered: first, the medicalization and biomedicalization as concentric ringed processes in three levels: macro, meso and micro, deepening the analysis in the latter. Second, the link between diagnostic and treatment processes in mental health and the biosocialities. Some considerations on sociology of time are also incorporated. The results show the incidence of the ASD diagnosis over time, in four areas: the transformation of daily activities, by attending therapeutic spaces; the expectations regarding free time and leisure; the changes that, if possible, have been made in the time the children diagnosed with ASD have been carrying out the therapy; and the beliefs and thoughts of their relatives about the future of the children diagnosed with ASD. Fil: Bianchi, Eugenia. Universidad de Buenos Aires. Facultad de Ciencias Sociales. Instituto de Investigaciones "Gino Germani"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Rodríguez Jurado, Stephany. Universidad de Buenos Aires. Facultad de Derecho; Argentina

This article examines historical trends in the reporting of health, illness and medicine in UK and Italian newspapers from 1984 to 2017. It focuses on the increasing “biomedicalization” of health reporting and the framing of health and medicine as a matter of technoscientific interventions. Methodologically, we relied on two large datasets consisting of all the health- and medicine-related articles published in the online archives of The Guardian (UK) and la Repubblica (Italy). These articles underwent a quantitative analysis, based on topic modelling techniques, to identify and analyse relevant topics in the datasets. Moreover, we developed some synthetic indices to support the analysis of how medical and health news are “biomedicalized” in media coverage. Theoretically, we emphasise that media represent a constitutive environment in shaping biomedicalization processes. Our analyses show that across the period under scrutiny, biomedicalization is a relevant, even if sometimes ambivalent, frame in the media sphere, placing growing centrality on three dimensions: i) health and well-being as a matter of individual commitment to self-monitoring and self-surveillance; ii) biomedicine as a large technoscientific enterprise emerging from the entanglement between research fields and their technological embodiments; iii) the multiverse reforms of welfare systems in facing the trade-off between universal health coverage and the need to render the national healthcare system more sustainable and compatible with non-expansionary monetary policies and austerity approaches in managing state government budgets.

Esta dissertação tem por objetivo explorar a emergência da Profilaxia Pré-Exposição (PrEP), enquanto uma importante “inovação” biomédica no campo da prevenção ao HIV/AIDS, considerando a proeminência de um debate público mais amplo sobre a epidemia na cidade de Porto Alegre. Tal “inovação” biomédica recentemente foi incorporada ao Sistema Único de Saúde (SUS) do Brasil. Parte-se de discussões acerca do processo de biomedicalização da resposta à epidemia e da presença de movimentos sociais na constituição do que chamo de um debate público, entendido como parte integrante das políticas de produção do conhecimento que cercam o HIV/AIDS. Nesse sentido, procura-se reconhecer e explorar diferentes temporalidades associadas a um momento em que se manifesta a consolidação de importantes promessas no campo, ao mesmo tempo em que são notados retrocessos marcantes na política nacional de resposta à epidemia. Explorando essas temporalidades, a presente investigação procura evidenciar performances específicas da promessa carregada pela PrEP e como esta promessa participa desse debate público. A etnografia foi realizada se valendo de diferentes abordagens teórico-metodológicas, incindindo em técnicas como a análise documental, a observação participante e o recurso a entrevistas semi-estruturadas. Foram analisados documentos relativos ao processo de incorporação da PrEP pela via da Comissão Nacional de Incorporação de Tecnologias no SUS (Conitec), além de reportagens, artigos científicos e outras publicações que pudessem ser úteis para uma descrição do processo de incorporação da tecnologia de prevenção. São descritos eventos marcantes que ocorreram na cidade de Porto Alegre, a fim de evidenciar quais são os termos do debate público sobre HIV/AIDS, num momento em que a PrEP começa a se consolidar enquanto política pública no sistema de saúde. Nota-se a partir das entrevistas realizadas com voluntários do Grupo de Apoio à Prevenção da AIDS do Rio Grande do Sul (GAPA-RS) e de um comitê que assessora um ensaio clínico internacional envolvendo a PrEP em Porto Alegre, os sentidos que ganham a prevenção ao HIV/AIDS e a intervenção biomédica em meio a esse debate público, por parte da histórica participação dos movimentos sociais na resposta à epidemia. This dissertation aims to explore the emergency of Pre-Exposure Prophylaxis (PrEP), as an important biomedical “inovation” in the field of HIV/AIDS prevention, considering the prominence of a wider public debate surrounding the epidemics in the city of Porto Alegre. This biomedical “inovation” recently was incorporated in the brazilian Sistema Único de Saúde (SUS). Discussions about the process of biomedicalization of the response to the epidemics and the presence of social movements in the constitution of what I call a public debate, understood as an integral part of the politics of knowledge production in the field of HIV/AIDS, serve as a starting point to this ethnography. In this direction, it is intended to acknowledge and explore different temporalities associated to a moment in which important promisses in the field begin to consolidate, at the same time it is attemped to note the marked setbacks in the national policy of response to the epidemic. Exploring these temporalities, the present investigation seeks to shed light on specifics enactments of the promise which PrEP carries and how this promise takes part in this public debate. The ethnography was conducted in several theoretical-methodological approaches, focusing in techniques of documentary analysis, participant observation and semi-structured interviews. Documents published by the Comissão Nacional de Incorporação de Tecnologias no SUS (Conitec) were included in the documentary analysis, which also covered up other publications such as news articles, scientific literature and materials which could be useful to describe the process of incorporation regarding this technology of prevention. Prominent events which have taken place in Porto Alegre are described, aiming to call atetion to what is mobilized in the public debate, in a moment in which PrEP begin to consolidate as a public policy in the brazilian health system. It is noted, in regards to the interviews conducted with volunteers of the Grupo de Apoio à Prevenção da AIDS do Rio Grande do Sul (GAPA-RS) and of a committee advising an international PrEP clinical trial, the meanings that encompasses HIV/AIDS prevention and the emergent biomedical intervention, considering the historic participation of social movements in the response to the epidemics.

The coproduction idiom within Science and Technology Studies (STS) centers on how science and society produce knowledge together. The current thesis explores expert communication – which is immersed in the relationship between science and society – as a case for understanding such coproducing processes. Expert communication is often characterized as a democratic initiative of knowledge enlightenment. But we know less about the consequences that communication initiatives bring. For instance, while groups of publics and experts are large and heterogeneous, expert communication often involves simplified and dichotomized relationships between these groups. The aim of this thesis is to understand the practice of expert communication in terms of how expertise is communicated and received. Who gets to represent experts and publics, in what ways and in which situations, and how do they engage with expertise? Expert communication takes place in all kinds of fields. The focus of this thesis is communication of addiction expertise. The addiction field makes a suitable case for studying co-constitutive practices of communication, as it is broad and disparate, and filled with different contradictory perspectives, actors and relations. The current study explores communication of addiction expertise through three cases that involve different types of experts and publics, as well as different dimensions of the expert/public relationships and of communication as a process of coproduction: Newspaper readers’ interpretations of media representations of biomedical addiction expertise, conference participants’ collaboration within a conference on codependency, and civil servants’ and politicians’ interaction within county council committee meetings. Drawing on STS approaches of coproduction of knowledge and classical sociological conversation analysis, the thesis explores questions of how, what, and whose knowledge is communicated and received, and what activities and actors are involved in these processes. A specific focus is put on how sociability in the form of conversational routines is productive, as sociability carries expertise and establishes relations between actors involved in coproducing processes of communication. Publics are not only recipients of expertise but also active enablers of how expertise comes into being in the everyday society, as publics engage with expertise through filtering and intertwining expertise through and with their personal experiences. Expertise, at least regarding human and social activities such as addiction, is thus bound to everyday experiences and lives. It is also shown how certain expertise, certain experiences, and certain actors and victims of addiction related problems are included while others are excluded. For example, biomedical explanations such as the reward system and the brain disease model seem to co-exist well with peoples’ personal experiences in contrast to social scientific explanations. Moreover, certain actors manage to draw on personal experiences in multiple roles as both experts and publics. Introducing the concept of conversational coproduction, the studies also highlight the sociability and conversational routines involved in expert communication as crucial for (de)establishing relations and making expertise flow or freeze in local coproducing processes as well as for understanding consequences of expert communication and its relation to public participation and democracy. At the time of the doctoral defense, the following paper was unpublished and had a status as follows: Paper 3: Manuscript. Knowledge production, communication and utilization; Biomedical alcohol research as an emerging field of knowledge

Cet article cherche à comprendre la construction scientifique et médicale de la notion de « fragilité » des personnes âgées. Pour ce faire, il s’appuie sur l’analyse d’un corpus de littérature médicale, réalisée entre juillet et août 2016, et de données de terrain d’une enquête exploratoire auprès de professionnels de santé travaillant autour de la fragilité. Tout d’abord, le texte propose une contextualisation sociohistorique afin d’appréhender l’émergence de la catégorie de la « fragilité » dans le domaine de la gériatrie et de la santé publique française. Il s’interroge ensuite sur son inscription dans un processus plus large de médicalisation du vieillissement. Les données révèlent néanmoins des nuances dans l’usage de la catégorie de « fragilité », qui permettent d’identifier deux processus distincts : un premier, que nous pourrions appeler processus de sanitarisation, et un second qui conduirait à la biomédicalisation de la vieillesse. Ces deux processus se caractérisent non seulement par des postures scientifiques différentes, mais aussi par des acteurs et des prises en charge particulières de la fragilité. This article seeks to understand the scientific and medical construction of the notion of “frailty” of old persons. For this purpose, it relies on the analysis of a body of medical literature, conducted between July and August 2016, and field data of an exploratory survey of health professionals working around frailty. First, the text proposes a sociohistorical contextualization in order to understand the emergence of the category of “frailty” in the field of geriatrics and French public health. Then, we examine the question of the inclusion of the category of “frailty” in a broader process of medicalization of aging. The data nevertheless reveals nuances in the use of the category of “frailty”, showing that two distinct processes can be identified: one, which could called healthicization, and a second, triggering the biomedicalization of old age. These two processes imply not only different scientific postures but also actors and particular care for frailty.

Resumo Este artigo discute a produção de subjetividades e transformações corporais que ocorrem a partir do uso de recursos biomédicos. O fio condutor é a entrevista de uma usuária de implante hormonal. Foi concedida no escopo de um projeto que compreendeu a realização de entrevistas com médicos/as e pacientes/consumidoras de tratamentos hormonais, observações em eventos e análise de documentos. O caso ilustra a emergência de um novo tipo de “paciente-especialista-consumidor/a”, como tem sido descrito/a na bibliografia sobre os processos de biomedicalização da sociedade. Contudo, argumento que, para além desta caracterização, serve para problematizar o estabelecimento de fronteiras predefinidas entre os supostos fatores materiais e discursivos. Considerando a narrativa da entrevistada, percebe-se que a subjetividade produzida é dependente da atuação do implante hormonal, ao mesmo tempo em que o implante exige uma série de investimentos para produzir os efeitos esperados. Isto remete à necessidade de uma abordagem analítica que privilegie os diferentes processos de materialização implicados. Resumen Este artículo discute la producción de subjetividades y transformaciones corporales que ocurren a partir del uso de recursos biomédicos. El hilo conductor es una entrevista con una usuaria de implante hormonal, concedida en el contexto de un proyecto que incluía entrevistas con médicos/as y pacientes/consumidoras de tratamientos hormonales, observación en eventos y análisis de documentos. El caso ilustra la emergencia de un nuevo tipo de “paciente-especialista-consumidor/a”, como ha sido descrito/a en la bibliografía sobre procesos de biomedicalización de la sociedad. No obstante, argumento que, más allá de esta caracterización, el caso sirve para problematizar el establecimiento de fronteras predefinidas entre los supuestos factores materiales y discursivos de tales procesos. Al considerar la narrativa de la entrevistada, se percibe que la subjetividad producida depende de la actuación del implante hormonal y, a su vez, el implante le exige comprometerse con una serie de acciones para producir los efectos esperados. Esto remite a la necesidad de un abordaje analítico que privilegie los diferentes procesos de materialización implicados. Abstract This article discusses the production of subjectivities and bodily transformations related to the use of biomedical resources. Its guiding thread is an interview with a woman who is a hormonal implant user. This interview was carried out within the scope of a project that included interviews with physicians and patients/consumers of hormonal treatments, as well as observations at events and analyses of documents. The case illustrates the emergence of a new type of "patient-specialist-consumer", as has been described in the literature on the biomedicalization of society. Moreover, it serves to problematize the establishment of pre-defined boundaries between the supposed material and discursive factors. Considering the narrative of the interviewee, the subjectivity produced is dependent on the performance of the hormonal implant, at the same time that the implant requires a series of investments to produce the expected effects. This underscores the need for an analytical approach that highlights the different processes of materialization involved.

The article argues that so called self-rated health, the best known predictor of mortality, is a research artefact. In lay theories of health that are strongly influenced by biomedicine, health and death are closely related: the worse one’s health, the shorter one’s life. Therefore, self-rated health implicitly contains one’s estimate of how long one will live. However, it is well known that self-rated life expectancy can be obtained just as well via a direct question. In social – ethnic – groups whose lay theories of health are affected by biomedicine to a limited extent or not at all, the relationship between health and death may be much looser or qualitatively different. In these groups, self-rated health does not correlate with mortality or the correlation is weak. At the same time, upon direct questioning, these people should be just as good in estimating one’s life expectancy as anybody else. For these reasons, so called self-rated health is a redundant concept; an artefact that has been created via unacknowledged biomedicalization of health research. The argument draws on findings of comparative social science (anthropology), STS (Social and Technology Studies) and selected quantitative research.

Este artículo se sitúa en el campo de estudio de los procesos productivos y de la transición tecnológica en el cuidado de salud. Examina la entrada del capital financiero en el sector salud y sus disputas con el complejo médico-industrial. Avanza en la comprensión de cómo los sectores capitalistas, que lideran la reestructuración productiva en salud, apuestan a la potencia de los procesos de creación de nuevas subjetividades en la transformación y consolidación del actual modelo médico hegemónico y en la producción/reproducción de modos de agenciamientos capitalísticos. Usamos el concepto de biomedicalización para entender la radicalización del proceso de medicalización, concepto que se viene mostrando insuficiente para comprender los cambios observados. Comprender estos fenómenos facilita reconocer resistencias y líneas de fuga que posibilitan apuestas no mercantilistas en salud, creadoras de autonomía y valorización de la vida individual y colectiva. Este artigo situa-se no campo de estudo dos processos produtivos e da transição tecnológica da produção do cuidado em saúde. Examina a entrada do capital financeiro no setor saúde e suas disputas com o complexo médico-industrial. Avança na compreensão de como os setores capitalistas, que lideram a reestruturação produtiva na saúde, apostam na potência dos processos de criação de novas subjetividades na transformação e consolidação do atual modelo médico hegemônico e na produção/reprodução dos modos de agenciamentos capitalistas. Usamos o conceito de biomedicalização para entender a radicalização do processo de medicalização, que vem se mostrando insuficiente para compreender as mudanças observadas. A compreensão desses fenômenos facilita reconhecer resistências e linhas de fuga, que possibilitam apostas não mercantilistas na saúde, criadoras de autonomia e valorização da vida individual e coletiva. This paper is situated on the field of study of the working/productive process and the technological transition in health care. It examines the entrance of financial capital groups in the health sector and their struggles with the medical-industrial complex. It puts forward a comprehension of how the capitalist sectors, leaders of the restructuration of the working process in health, bet on the power of the creation of new subjectivities in order to transform and consolidate the current hegemonic medical model and the production/reproduction of the ways of the capitalism’s agency role. We use the concept of biomedicalization to understand a radical stage of medicalization, a commonly used concept, albeit insufficient to understand the observed changes. The comprehension of these phenomena allows the recognition of resistances and “lines of flight” that could allow for non-mercantilist options in health, which may create autonomy and reinforce the value of individual and collective life.

Resumo Este artigo focaliza a articulação entre pesquisa biomédica e indústria farmacêutica com base nos estudos da tecnociência. Abordamos o caso do medicamento Intrinsa – adesivo de testosterona, cujo propósito é o aumento do desejo sexual em mulheres – examinando artigos que relatam resultados de ensaios clínicos, publicados em periódicos científicos. Buscamos demonstrar como a população visada pelos ensaios clínicos foi paulatinamente expandida de modo a englobar um número cada vez maior de mulheres, o que pressupôs rearranjos na maneira de definir as disfunções para as quais o medicamento seria indicado e as possíveis causas subjacentes. Foi possível identificar três caminhos de ampliação do mercado para o Intrinsa: o primeiro baseou-se na alteração do status de menopausa. A terapia com testosterona passou a ser vinculada também ao envelhecimento (incluindo, portanto, a pré-menopausa e a menopausa “natural”) e não mais exclusivamente à menopausa cirúrgica; o segundo focalizou a dissociação entre o uso do Intrinsa e a terapia com estrógenos; o terceiro buscou vincular o medicamento ao aumento de “bem-estar”. Abstract This article focuses on the close relationship between biomedical research and the pharmaceutical industry based on technoscience studies. We discuss the case of Intrinsa – a testosterone patch designed to increase the sexual desire of women – through the analysis of articles reporting clinical trial outcomes published in scientific journals. We intend to demonstrate how the target population of the clinical trials was gradually expanded so as to include a growing number of women, and how this expansion led to alterations in the definition of the disorder the drug was supposed to treat and its possible underlying causes. We were able to identify three paths that aimed at extending the indication of Intrinsa: the first was based on the change in the menopausal status of women, since testosterone therapy began to be linked to aging (including, therefore, perimenopause and ‘natural’ menopause) and no longer exclusively to surgical menopause; the second focused on the dissociation between the use of Intrinsa and therapy with estrogens; the third sought to relate the drug to an increased sense of ‘well-being’.

A presente pesquisa tem como objetivo “seguir” a da substância testosterona e as maneiras pelas quais ela é performada como/em diversas realidades. A partir da perspectiva da Teoria Ator-Rede de Bruno Latour, toma-se o hormônio testosterona como um ator não-humano, o qual integra uma rede que articula diferentes campos como médico/jurídico/mercadológico. Para tanto, foram realizadas entrevistas etnográficas com um médico endocrinologista, dois personal trainer e participantes de academia, dois homens trans que fazem acompanhamento com um profissional da medicina, bem como foram analisados sites, fóruns, vídeos, bulas de medicamentos e artigos científicos. No decorrer da investigação, identificamos duas principais redes nas quais a testosterona é materializada, que estão em constante disputa/coordenação, as quais nomeei de “ciclos”, em referência aos ciclos de testosterona demonstrados por alguns interlocutores deste trabalho. Tais redes são: 1) Ciclo Fármaco-Biomédico, no qual destaca-se o acesso à substância mediado pelo discurso médico e; 2) Ciclo Fármaco-Bombado, no qual a testosterona circula através de outras formas de acesso, que burlam a mediação médico-paciente e/ou prescrição médica, como aquelas que ocorrem em academias de ginástica e nas vendas/trocas de hormônios realizadas por grupos de atletas e/ou grupos de homens trans. O principal objetivo do trabalho foi demonstrar as diversas maneiras pelas quais a testosterona é performada nessas múltiplas realidades, à luz da teoria praxiográfica neo-materialista de Anemarrie Mol, a partir das descrições da rede, e seus respectivos atores e articulações. Dessa forma, demonstra-se a dissolução do binarismo natureza-cultura pensando na utilização da testosterona para a materialização de corpos de sujeitos inscritos nas masculinidades. E mais que isso, expõe que a testosterona, ao multiplicar-se em práticas que envolvem tanto homens cis quanto trans, a partir do acesso dificultado por todos esses sujeitos à substância, dissolve as fronteiras imaginadas entre tais corpos, na medida em que todo o controle acerca da testosterona pelo domínio biomédico, impulsionado pela necessidade de imitar a fisiologia, demonstra um caráter moral que está diretamente ligado à utilização dessa substância. The present research aims to "follow" the testosterone substance and the ways in which it is performed as / in various realities. From the perspective of Bruno Latour's Theory-Actor Network, the testosterone hormone is taken as a non-human actor, which integrates a network that articulates different fields such as medical / legal / marketing. To that end, ethnographic interviews were conducted with an endocrinologist, two personal trainer and participants of the academy, two trans men who follow up with a medical professional, as well as the analysis of websites, forums, videos, medication packages and scientific articles. During the investigation, we identified two main networks in which testosterone is materialized, which are in constant dispute / coordination, which I named "cycles", in reference to the testosterone cycles demonstrated by some interlocutors of this work. These networks are: 1) Drug-Biomedical Cycle, in which the access to the substance mediated by the medical discourse is highlighted; 2) Drug-Bombed Cycle, in which testosterone circulates through other forms of access, which circumvent medical-patient mediation and / or medical prescription, such as those occurring in gyms and hormone sales / exchanges performed by groups of athletes and / or groups of trans men. The main objective of the work was to demonstrate the different ways in which testosterone is performed in these multiple realities, in the light of Anemarrie Mol's neo-materialistic praxiographic theory, from the descriptions of the network and their respective actors and articulations. Thus, it is demonstrated the dissolution of the nature-culture binarism thinking about the use of testosterone for the materialization of bodies of subjects enrolled in masculinities. And more than that, it exposes that testosterone, by multiplying itself in practices involving both cis and trans men, from the access made difficult by all these subjects to the substance, dissolves the imagined boundaries between such bodies, to the extent that all control over testosterone by the biomedical domain, driven by the need to imitate physiology, demonstrates a moral character that is directly linked to the use of this substance.

Artykuł zawiera analizę opowieści Amazonek-Ochotniczek - działających w jednym z polskich stowarzyszeń samopomocowych - na temat życia w czasie remisji choroby nowotworowej piersi. Podstawą rozważań są świadectwa etnograficzne w postaci obserwacji uczestniczącej i wywiadów narracyjnych prowadzonych podczas badań terenowych we wspomnianej grupie samopomocowej. Przedmiotem uwagi czynimy wariantywność opowieści rozmówczyń, a także hierarchizacje praktyk narracyjnych. W oparciu o typologię Artura Franka wyróżniamy dwa typy konstrukcji narracyjnych w opowieściach kobiet: narracje restytucji zdrowia oraz narracje poszukiwania. Pierwszy typ narracji, ujmujący chorobę i jej skutki jako stan przejściowy prowadzący do wyzdrowienia, stanowi modus operandi stowarzyszenia. Służy on przede wszystkim niesieniu nadziei i wsparcia osobom aktualnie chorującym. Narracje poszukiwania zdają sprawę z tego, co pomija narracja restytucji zdrowia, czyli przypadków wznowy raka, utraty poczucia kobiecości, a także osamotnienia, jakiego doświadczają osoby po mastektomii piersi. Analizowany przez nas przypadek zróżnicowanie narracji i praktyk narracyjnych w stowarzyszeniu samopomocowym rzuca światło na konsekwencje procesów biomedykalizacji chorób. Biorąc pod uwagę analizowane świadectwa można stwierdzić, że systemy i aparaty biomedyczne współkształtują, ale nie determinują w całości sposobów narratywizowania doświadczenia remisji raka piersi. Narracje restytucji zdrowia dominują w wielu kontekstach działalności stowarzyszenia, narracje poszukiwania ujawniają się w prywatnych rozmowach i wywiadach biograficznych - widać w nich sprawstwo kobiet. Przełamują schemat narracji restytucji zdrowia,będący wyrazem biomedycznego sposobu myślenia o chorobie i życiu w czasie remisji choroby. Wymowa opowieści poszukiwania pozostaje ambiwalentna. Poczucie dumy z pokonania choroby i znalezienia trwałych znaczących relacji z innymi miesza się w nich z doświadczeniem wznowy, poczuciem utraty kobiecości, osamotnieniem. Artykuł jest przyczynkiem do dyskusji o przemianach społecznej i politycznej organizacji doświadczenia życia z remisją choroby nowotworowej w efekcie biomedykalizacji. Analiza pokazuje pewien przypadek zróżnicowania konstrukcji narracyjnych i praktyk narratywizowania. Narracje restytucji zdrowia dominują w publicznych wystąpieniach kobiet, narracje poszukiwania spycha się do sfery prywatnej i nieformalnych wypowiedzi. Są one wyrazem sprawstwa osób po mastektomii, chociaż nie stanowią zarzewia buntu wobec dominujących publicznie sposobów narratywizowania doświadczenia raka piersi i życia w czasie remisji tej choroby. This paper scrutinizes fifteen life stories told by volunteer activists from a breast cancer support group operating in southern Poland; highlighted is life in remission. The analysis is based on ethnographic materials (i.e., in-depth interviews, participant observation) gathered during fieldwork conducted by one of the authors. We especially focus on variation and ambiguity in these remission narratives. Drawing on Arthur Frank’s typology of illness narratives, we distinguish two strains: the "restitution" and the "quest" narratives (which are combined by our interlocutors). The former is a construct which presumes that cancer is a transitory physical condition which can be successfully cured, taking post-treatment patients back to the initial state of health. This type of narrative constitutes a modus operandi for the support group whose essential task is to instill hope in women suffering from breast cancer. The latter narrative type seems more complex and more sensitive to the particularities and precariousness of the embodied biography. It underscores a quest for establishing meaningful relationships in a life affected by multiple defeats. Considering the remission narratives analyzed herein, the authors of this paper conclude that the system and apparatus of biomedicine do influence, but do not wholly determine the ways in which the breast cancer experience is narrativized. The restitution narratives dominate in various realms of group life while the space for quest narratives is secluded. Nonetheless, the quest narratives embody the women’s agency. They break with dominant restitution narratives as they address painful issues of health and gender, identity loss, cancer recurrence, sense of loneliness - the topics that are excluded from the restitution narratives. These quest narratives are ambiguous in their meaning and relegated only to private conversations and interviews. This text aims at contributing to a discussion about the shifts in the social and political organization and experience of remission life as a result of new technological developments and their global expansion in the last decades. Inasmuch as cancer experiences were relegated to the private sphere of patients in remission, today biosocial communities emerge in which these experiences are narrativized. Such autobiographies are characterized by ambiguity and an embodied diversity of narrative constructions. The quest narratives of post-mastectomy women discloses agency although they are not intended to bring radical change in the way cancer experience and remission life is publicly narrativized.

addicted.pregnant.poor is an ethnography addressing the biomedical, social, political, and ethical dimensions of ongoing illicit drug use during pregnancy. A result of four years of fieldwork in daily-rent hotels – privately owned buildings in which the exploitation of women’s sex work and on-going poor health was normative – the book follows nineteen women who had twenty-three pregnancies. To answer the question ‘What forms of life are possible here?’ I engaged with the social actors who are called upon to produce knowledge about addicted pregnancy, including addicted, pregnant women; an anthropologist; public health epidemiologists; advocates; social policymakers; treatment professionals; bureaucrats; and scientists. In this essay, I describe the relationship between the scientific contours of reproductive health and the personal and social consequences of pregnancy in the context of addiction and housing instability. Pregnant women in the daily-rent hotels existed within multiple temporalities. Here I explore what an ethnographic understanding of memorial time and biomedical time can teach us about the vital politics of viability at work in addicted pregnancy.

Resumo A partir de etnografias realizadas em serviços públicos e privados do Rio de Janeiro, sustentamos que a difusão do fenômeno de (bio)medicalização varia de acordo com o estrato social das gestantes, produzindo corpos fetais e gestantes, assim como processos gestacionais, totalmente diversos, dependendo da camada social das mulheres atendidas. Tomando a premissa fundamental de que a biomedicalização consiste em uma transformação no processo de medicalização pela incorporação crescente da tecnociência à biomedicina, o universo observado evidencia diferentes estágios dessa transformação, acompanhando, de modo consistente, a estratificação social das grávidas submetidas ao exame de ultrassom. Abstract Based on ethnographic studies conducted at public and private healthcare facilities in Rio de Janeiro, we argue that the dissemination of (bio)medicalization varies in accordance with the social stratum of the expectant mothers, thereby producing thoroughly distinct fetal and pregnant bodies, as well as different gestational processes. Starting from the basic premise that biomedicalization represents a transformation in the process of medicalization, characterized by the growing incorporation of technoscience into biomedicine, the observed universes displayed different stages in this transformation, consonant with the social stratification of the women who underwent the scans.

This dissertation began as an attempt to understand how biomedical concepts and practices, which undermine the salience of norms drawn from the “natural order” are relayed through mass media and inform self-understanding, social being, self-care, and practices of everyday life. The project tracks makeover TV’s valorization of the metamorphic or transformative body as an ideal that emerges through, and across, various contexts in science and popular culture. This genre of programming is one of the few sites at which the aesthetics of biotechnology are made visible in non-fiction representations and are depicted as part of everyday life. Each of this dissertation’s televisual case studies is exemplary of how popular culture absorbs and makes visible ideas from biomedicine, and how this relates to public policy, economic conditions, and developments in biomedicine.Harnessing biomedicine has aided in television’s recreation of itself as an essential element of “new” media. It has done so by presenting itself as a technology for managed health care at a distance, and by presenting the body as a primary medium of self-expression. Television encourages ideas about the body as “transmedial continuity” or form of media, both physical and symbolic, represented through and across variable sites, objects and platforms. Under the aegis of “health,” medical makeover programs establish a direct relationship between body-based visual identity and life, promote biomedicine as a ubiquitous means of conceiving of the self and body, and posit biotechnology as a tool for transformation and self-care. In this context, health becomes a visual ideal and an organizing principle for self-care, which are framed as prerequisites for social, economic, and political legibility. Although biomedicine challenges essentialist models of “natural order” through which misogynist and racist norms have been justified in modern culture, its appearances in narratives of self-transformation are overwhelmingly framed by politically retrogressive ideals of embodiment, which it aids in achieving. Given the pervasiveness of visual media and its centrality in refiguring norms that have social, biological and political significance, media literacy and critical acuity are crucial to preserving both cultural and bio diversity.

HIV treatment as prevention is an emerging biomedical prevention approach that seeks to utilize routine HIV testing, linkage to and engagement in HIV care, and the consumption of antiretrovirals in order to suppress individuals’ viral loads, greatly reducing or eliminating the risk of onward transmission of HIV. Drawing on interviews with HIV scientists, policymakers, clinicians, and leaders in HIV community advocacy, ethnographic field work at three global HIV scientific meetings, and extant narrative, visual and material data, this multi-sited study explores the emerging professional discourses that are co-constitutive of HIV treatment as prevention. Through an inductive process of data collection and analysis, four broad analytic problem spaces emerged: the reconfiguring of HIV risk discourses through pharmacological non-infectiousness, the transformations in biomedical surveillance practices as well as subjectivities via a prioritization of viral suppression and viral load monitoring, and the construction of antiretrovirals themselves as technoscientific ‘things’ which both potentiate and disrupt their own use as prevention technologies, in particular, via an anticipatory orientation to the future. This project contributes to work on biomedicalization, particularly on theorizing about transformations of risk and surveillance practices, subjectivity and forms of biomedical citizenships, as well as work on anticipation, notably on the creative effect of biomedical technologies and imagined futures.

The emerging concept of systems medicine (or ‘P4 medicine’—predictive, preventive, personalized and participatory) is at the vanguard of the post-genomic movement towards ‘precision medicine’. It is the medical application of systems biology, the biological study of wholes. Of particular interest, P4 systems medicine is currently promised as a revolutionary new biomedical approach that is holistic rather than reductionist. This article analyzes its concept of holism, both with regard to methods and conceptualization of health and disease. Rather than representing a medical holism associated with basic humanistic ideas, we find a technoscientific holism resulting from altered technological and theoretical circumstances in biology. We argue that this holism, which is aimed at disease prevention and health optimization, points towards an expanded form of medicalization, which we call ‘holistic medicalization’: Each person’s whole life process is defined in biomedical, technoscientific terms as quantifiable and controllable and underlain a regime of medical control that is holistic in that it is all-encompassing. It is directed at all levels of functioning, from the molecular to the social, continual throughout life and aimed at managing the whole continuum from cure of disease to optimization of health. We argue that this medicalization is a very concrete materialization of a broader trend in medicine and society, which we call ‘the medicalization of health and life itself’. We explicate this holistic medicalization, discuss potential harms and conclude by calling for preventive measures aimed at avoiding eventual harmful effects of overmedicalization in systems medicine (quaternary prevention). This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Presento resultados de una investigación postdoctoral que aborda el análisis de las transformaciones recientes en los diagnósticos en salud mental infantil, a través del estudio de dos categorías: TDAH (Trastorno por Déficit de Atención e Hiperactividad) y TEA (Trastorno del Espectro Autista). Empleando métodos analítico-interpretativos sobre bibliografía específica, recupero y sistematizo tópicos trabajados desde perspectivas de la medicalización y la biomedicalización, y estudios sobre el riesgo en salud mental, para el análisis de las tipificaciones psiquiátricas mencionadas. Como un aporte a estos campos, desarrollo la hipótesis según la cual las reformulaciones acaecidas en el manual de clasificación psiquiátrica DSM-5 en el TDAH y TEA, pueden entenderse a la luz de las características más amplias de los procesos de medicalización y biomedicalización que recaen con énfasis en las infancias. This article presents the results from postdoctoral research that addresses recent transformations in the diagnosis of children’ s mental health through the analysis of two categories: ADHD (Attention Deficit Hyperactivity Disorder) and ASD (Autism Spectrum Disorder). Using analytical and interpretative methods taken from a specialist bibliography, the author recovers and systematizes topics addressed from the perspectives of medicalization and biomedicalization. Studies on risks to mental health are also used for the analysis of the psychiatric classifications analysis already mentioned. As a contribution to these fields, the author develops the hypothesis that the changes made to the DSM-5 psychiatric classification manual, specifically for ADHD and ASD can be understood in the light of the broader processes of medicalization and biomedicalization that have a particular focus on childhood. Apresenta-se os resultados de uma pesquisa de pós-doutorado que aborda a análise das transformações recentes nos diagnósticos de saúde mental infantil por meio do estudo de duas categorias: TDAH (Transtorno de Déficit de Atenção e Hiperatividade) e TEA (Transtorno do Espectro do Autismo). Utilizando métodos analíticos e interpretativos sobre literatura específica, o artigo recupera e sistematiza temas trabalhados a partir de perspectivas de medicalização e biomedicalização e de estudos sobre o risco de saúde mental para a análise das caracterizações psiquiátricas mencionadas. Como contribuição a esses campos, se desenvolve a hipótese de acordo com as reformulações ocorridas no manual de classificação psiquiátrica DSM-5 em TDAH e TEA e como elas podem ser entendidas à luz das características mais amplas dos processos de medicalização e biomedicalização que têm ênfase na infância.

The Shifting Borders of Medicalization: Perspectives and Dilemmas of Human Enhancement - While medicalization is the process of extending the medical gaze on human conditions through the mechanism of pathologization, human enhancement actions are implemented towards normal conditions. In this sense, human enhancement can not be considered either health care or health promotion because its aim is optimization, not healing nor prevention. As the borders between normality and pathology are blurred, biomedical interventions aiming at improving a normal individual today could be conceived as health care practices directed towards a sick person tomorrow. Therefore, human enhancement actions should be analyzed through the lenses of the medicalization-theory proposed by Conrad - but on a long-term scale. Under an ethical perspective, human enhancement interventions - being very heterogeneous - should be analyzed case-by-case. Keywords: medicalization, human enhancement, medicine, normality, health promotion, disease. Parole chiave: medicalizzazione, miglioramento umano, medicina, normalita, promozione della salute, malattia.

The shift in the prevailing view of alcoholism from a moral paradigm towards a biomedical paradigm is often characterized as a form of biomedicalization. We will examine and critique three reasons offered for the claim that viewing alcoholism as a disease is morally problematic. The first is that the new conceptualization of alcoholism as a chronic brain disease will lead to individualization, e.g., a too narrow focus on the individual person, excluding cultural and social dimensions of alcoholism. The second claim is that biomedicalization will lead to stigmatization and discrimination for both alcoholics and people who are at risk of becoming alcoholics. The third claim is that as a result of the biomedical point of view, the autonomy and responsibility of alcoholics and possibly even persons at risk may be unjustly restricted. Our conclusion is that the claims against the biomedical conceptualization of alcoholism as a chronic brain disease are neither specific nor convincing. Not only do some of these concerns also apply to the traditional moral model; above that they are not strong enough to justify the rejection of the new biomedical model altogether. The focus in the scientific and public debate should not be on some massive “biomedicalization objection” but on the various concerns underlying what is framed in terms of the biomedicalization of alcoholism.

Esta dissertação explora o tema da medicalização. A pesquisa toma como objeto a promoção do fármaco Cloridrato de Metilfenidato, conhecido pelo nome comercial: Ritalina®. Trata-se de uma droga psicoestimulante atualmente estabelecida como tratamento de primeira linha para o TDA/H (Transtorno de Déficit de Atenção/Hiperatividade). A literatura especializada afirma que o TDA/H é uma doença de alta prevalência em crianças em idade escolar, sendo o “distúrbio neurocomportamental” mais comum na infância. Dados epidemiológicos sobre a expansão da prevalência do TDA/H e sobre aumento do consumo da Ritalina® somados às complexas relações entre diversos atores (indústria farmacêutica, pesquisadores e publicitários) sugerem que, além da apropriação dos modos de vida das pessoas pela medicina, está sendo estabelecido um vasto mercado corporativo. Este trabalho acompanha a trajetória da Ritalina® a partir da análise de material promocional destinado a profissionais da área médica. As propagandas examinadas foram encontradas através do buscador google e do Portal de Periódicos da Capes (periodicos.capes.gov.br) e compreendem o período de 1956 - quando Ritalina® foi lançada nos EUA – até 1979. Selecionei 32 informes publicitários para serem analisados, baseando-me em critérios como qualidade das imagens, confiabilidade e origem das fontes. Os anúncios mostram que este psicofármaco foi inicialmente indicado para problemas distintos como depressão, fadiga, letargia e narcolepsia. Ao fim da década de 1960 a Ritalina® passa a ser reconhecida como tratamento eficaz para “crianças hiperativas”. Argumento que ao considerarmos propagandas produzidas por laboratórios farmacêuticos como documentos legítimos é possível contribuir para resgatar aspectos históricos de determinada droga que de outro modo poderiam passar desapercebidos, uma vez que este tipo de material caracteriza-se como um elemento imprescindível no arsenal persuasivo dessas empresas. This dissertation examines the promotion and advertisement for Ritalin (a trade name for methylphenidate). Ritalin® is a psychostimulant medication used for the treatment of attention deficit hyperactivity disorder (ADHD). ADHD is one of the most common childhood disorders and can continue through adolescence and adulthood. Symptoms include hyperactivity, difficulty staying focused, paying attention and difficulty controlling behavior. The worldwide prevalence estimates of attention deficit hyperactivity disorder (ADHD) are highly variable. The current study aims to examine how Ritalin®, originally promoted by Ciba as a mild antidepressant, became the drug of first choice to treat ADHD (known at the time as hyperactivity or minimal brain dysfunction). This dissertation examines the development of methylphenidate treatment and the expansion of the diagnostic category of ADHD through the analysis of pharmaceutical advertisements for Ritalin® in US and Canadian medical journals published between 1956 and 1970’s. Most of the journals were retrieved from Portal de Periódicos da Capes and MEDLINE searches. I selected a sample of 32 advertisements to analyze, based mainly on image quality. These pharmaceutical advertisements show that this psychotropic initially market for mild depression and mood disorders, fatigue, lethargy and narcolepsy. By the end of the 60’s, Ritalin is being shown – and renowned – as an effective treatment for “hyperactive children”. I suggest that when we consider pharmaceutical advertisement material as a legitimate documental source, it is possible contributing to retrieve historical aspects of a specific drug, which might otherwise go unnoticed, since this type of material is characterized as an essential component in the persuasive arsenal of those companies.

New biomedicalized forms of longevity, anti-aging ideals, and the focus on successful aging have permeated the current sociocultural and political climate, and will affect the future of aging. This article examines changing attitudes towards sexual practices and the perception of sexuality in later years, as exemplified in Erica Jong’s middle and late life works and interviews. Instead of succumbing to anti-aging culture and biomedicalization of sex in old age, Jong reveals alternative ways of exploring sexual practices in older age, and challenges a pharmaceutical market that promotes the consumption of medication to enhance the idea of virility and ‘sexual fitness’ in older men. Jong’s work undoes the narrative of decline that portrays older individuals as sexually inactive and frail, and, at the same time, shows that the interest in sexual intercourse and the erect phallus gradually becomes less important as people grow older. This qualitative narrative analysis opens the discussion for reconsideration of late-life sexuality beyond biomedical understandings of late-life sex and old age. The study also reveals how a literary approach can provide alterative and more realistic perspectives towards sexual experiences in later stages of life that can have significant implications for healthcare policy and the future of aging.

This thesis explores the increasing medicalization of society, the process whereby social phenomenon are transformed into medical problems. Alike the general tendency of neuropsychiatric diagnoses, the number of people with ADHD (Attention Deficit Hyperactivity Disorder) has increased and expanded from a boys’ diagnosis to include both adult men and women. Studies on the latter category is however scarce. The objective of the thesis is to contribute with a micro sociological and critical perspective on the effects of the biomedicalization process, by focusing women's experience of getting and living with ADHD. The empirical material consists of narrative interviews with sixteen women, diagnosed with ADHD in adulthood. The participants, age 20 to 50, were enrolled via Swedish NGOs in 2010 and 2013. The thesis resides on four analytical themes: biomedicalization, pharmaceuticalizaton, functionality and gender. It shows how diagnostics evokes processes that involve learning and using a biomedical terminology to describe and understand oneself. ADHD is, in general, depicted as diffuse, expansionary, masculine and deviant sociability and cognitivity. Unlike depression and anxiety, described as temporary and unwanted illnesses, the ADHD-diagnosis embraces the whole personality. Hence, the women find it difficult to identifying and separating ADHD from the self. Furthermore, categorizations of oneself as a ‘woman with ADHD’ imply constructions of individual and collective identity that has ideological implications, i.e. the individual narratives are related to grand narratives. These contradictory grand narratives bring about ideological dilemmas that are handled rhetorically in the women's everyday life. The masculine connotation of ADHD, for example, render the women experiencing themselves as transgressing not only femininity but also ADHD-personhood. Additionally, as social actions are attributed to the ‘ADHD brain’, the brain is portrayed as a pathological deviant and dysfunctional object for pharmaceutical intervention. Nevertheless, this discourse is also contested by the women by pointing to 1) positive aspects of the ‘ADHD-brain’ in everyday life, or 2) gender inequalities and demands of the late-modern society. Concluding, the women in this study are not only victims of their bodies or societal norms, but also agents negotiating – adapting and opposing to – expectations of how to be an ideal citizen or woman.

Submitted by Boris Flegr (boris@uerj.br) on 2020-07-05T16:05:56Z No. of bitstreams: 1 Gisela Giannerini Santos - Dissertacao.pdf: 874877 bytes, checksum: f1d47799f1e8258529f2e52be19157b7 (MD5) Made available in DSpace on 2020-07-05T16:05:56Z (GMT). No. of bitstreams: 1 Gisela Giannerini Santos - Dissertacao.pdf: 874877 bytes, checksum: f1d47799f1e8258529f2e52be19157b7 (MD5) Previous issue date: 2013-04-30 Conselho Nacional de Desenvolvimento Científico e Tecnológico This study aims to present a historical review of the medicalization concept, analyzing how the understanding about of this process has changed in the past decades, moving from a orthodox point of view that considered this to be the result of a medical imperialism process on the society, until a modern-day critics, guided by a more nuanced understanding of the theme. Among the major changes in the reading of the medicalization, is the perception of it as an interactive and collective process, composed of numerous key players, each one with different interests and roles nowadays. While early authors of the 70 emphasized the social control and the damage caused by medicine, in a more recent approach individuals are no longer seen as victims, but as important advocates for medicalization. The individuals have begun to play a more significant role in this process, becoming key actors of a public debate about the ever-shifting boundary that legislate on the processes of health and disease. The notion of medicalization advanced towards a complex approach, bringing challenges that are quite different nowadays. Finally, we highlight a central development of this research presenting a more thorough review on the subject, especially regarding the issue of narrowing the normal, where the concept of medicalization can function as a useful conceptual tool of analysis. The example of psychiatry is mentioned as an analyzer question in this discussion, considering the social role historically played by this in the delimitation of boundaries that still deal with old problems about normality and abnormality. Therefore, this study provides a historical review of the concept of medicalization through the most relevant contributions of the international literature. Essa dissertação tem por objetivo apresentar, de forma panorâmica, uma revisão histórica sobre o conceito de medicalização, analisando como o entendimento sobre este processo se transformou nas últimas décadas, passando de críticas mais ortodoxas, que julgavam ser este processo fruto de um imperialismo médico sobre a sociedade, às críticas contemporâneas, orientadas por uma compreensão mais nuançada a respeito do tema. Dentre as principais mudanças na leitura da medicalização, está o entendimento desta enquanto um processo interativo e coletivo, composto por inúmeros participantes-chave com interesses e papéis distintos na atualidade. Enquanto os primeiros teóricos da década 70 realçam a crítica ao controle social e malefícios da medicina, numa abordagem mais recente os indivíduos deixam de ser vistos como vítimas para protagonizarem o cenário de negociação pública acerca das fronteiras que legislam sobre os processos de saúde e doença. A noção de medicalização caminhou no sentido de uma complexidade maior, trazendo desafios que não são tão facilmente resolvíveis na conjuntura contemporânea. Ao final, destacamos como um dos desdobramentos centrais desta dissertação a pertinência atual de uma revisão mais apurada sobre o assunto, principalmente no que concerne ao tema do estreitamento da normalidade, onde o conceito de medicalização pode funcionar como uma ferramenta conceitual útil de análise. Aludimos ao exemplo da psiquiatria como um analisador nessa discussão, considerando o papel social historicamente desempenhado por esta na delimitação de fronteiras que, no fundo, ainda versam sobre antigos dilemas sobre normalidade e anormalidade. Para tanto, este estudo traz uma revisão histórica sobre o conceito de medicalização através das contribuições mais relevantes da literatura internacional.

El artículo analiza críticamente el aumento de los niños diagnosticados y tratados por el Trastorno de Déficit de Atención e Hiperactividad (TDAH). Los análisis vinculan este creciente fenómeno con las estrategias de la industria farmacéutica para reposicionarse en el liderazgo de la conceptualización del proceso salud-enfermedad-atención y en el mercado de salud. Utilizamos métodos analítico-interpretativos para estudiar datos primarios y secundarios, y realizar una extensa revisión bibliográfica. A la luz del concepto de biomedicalización analizamos los mecanismos subjetivo-ideológicos que facilitaron que este discurso se instituya como una nueva verdad sobre este trastorno y sea legitimado por los organismos gubernamentales y las organizaciones de la sociedad civil. La biomedicalización del sufrimiento infantil dificulta que se pongan en evidencia los profundos cambios socioeconómicos, políticos e ideológico-culturales que han transformado radicalmente nuestras sociedades en las últimas décadas. The article critically analyzes the increasing number of children diagnosed with and treated for Attention Deficit Hyperactivity Disorder (ADHD). The analysis links this growing phenomenon with the strategies of the pharmaceutical industry to attain leadership in the health-illness-care process as well as in the health market. We utilized analytical and interpretive methods to study primary and secondary data and conducted an extensive literature review. In light to the concept of biomedicalization, we analyzed the ideological and subjective mechanisms that facilitated the institutionalization of this discourse as a new truth concerning this disease as well as its legitimization by governmental and civic organizations. The biomedicalization of children's suffering facilitates the concealment of deeply rooted socio-economic, political, ideological and cultural changes that have radically transformed our societies over the past few decades. O artigo analisa criticamente o aumento das crianças diagnosticadas e tratadas por Transtorno de Déficit de Atenção de Hiperatividade (TDAH). As análises vinculam este crescente fenômeno às estratégias da indústria farmacêutica para se reposicionarem na liderança da conceituação do processo saúde-doença-atenção e no mercado de saúde. Utilizamos métodos analítico-interpretativos para estudar dados primários e secundários, e realizar uma extensa revisão bibliográfica. À luz do conceito da biomedicalização, analisamos os mecanismos subjetivo-ideológicos que facilitaram que este discurso se institua como uma nova verdade sobre este transtorno e seja legitimado pelos organismos governamentais e organizações da sociedade civil. A biomedicalização do sofrimento infantil dificulta que se revelem as profundas mudanças socioeconômicas, políticas e ideológico-culturais que têm transformado radicalmente nossas sociedades nas últimas décadas.