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Heroin overdose, more accurately termed ‘heroin-related overdose’ due to the frequent involvement of other drugs, is the leading cause of mortality among regular heroin users. (Degenhardt et al., 2010) Heroin injectors are at greater risk of hospital admission for heroin-related overdose (HOD) in the eastern United States where Colombian-sourced powder heroin is sold than in the western US where black ‘tar’ heroin predominates. (Unick et al., 2014) This paper examines under-researched influences on HOD, both fatal and non-fatal, using data from a qualitative study of injecting drug users of black tar heroin in San Francisco and powder heroin in Philadelphia Data were collected through in-depth, semi-structured interviews carried out in 2012 that were conducted against a background of longer-term participant-observation, ethnographic studies of drug users and dealers in Philadelphia (2007–12) and of users in San Francisco (1994–2007, 2012). Our findings suggest three types of previously unconsidered influences on overdose risk that arise both from structural socio-economic factors and from the physical properties of the heroin source-types: 1) retail market structure including information flow between users; 2) marketing techniques such as branding, free samples and pricing and 3) differences in the physical characteristics of the two major heroin source forms and how they affect injecting techniques and vascular health. Although chosen for their contrasting source-forms, we found that the two cities have contrasting dominant models of drug retailing: San Francisco respondents tended to buy through private dealers and Philadelphia respondents frequented an open-air street market where heroin is branded and free samples are distributed, although each city included both types of drug sales. These market structures and marketing techniques shape the availability of information regarding heroin potency and its dissemination among users who tend to seek out the strongest heroin available on a given day. The physical characteristics of these two source-types, the way they are prepared for injecting and their effects on vein health also differ markedly. The purpose of this paper is to examine some of the unexplored factors that may lead to heroin-related overdose in the United States and to generate hypotheses for further study. [ABSTRACT FROM AUTHOR]

Abstract: It has been frequently acknowledged that results of predictive genetic tests may have implications for relatives as well as for the individual client. Ethicists have noted that an individual’s right to know her genetic risk may conflict with a relative’s right not to know this risk. It is hardly recognised, however, that family members may have a role in the production of test results as well. This article reconstructs the actual process of predictive BRCA-testing in the Netherlands, with a special focus on the roles assigned to clients and families and the expectations about family relationships inscribed in this practice. Fieldwork was carried out in an outpatient clinic for clinical genetics in an academic hospital. Data collection included 11 interviews with members of families, observations of counselling interviews between research participants and their clinical geneticist, and interviews with the 2 clinical geneticists involved in the consultations. It compares this process to the American practice of BRCA-testing. Whereas Dutch practice presupposes active involvement of diseased relatives in the testing process, American practice constitutes the client primarily as an independent individual who may or may not decide to involve her relatives. Moreover, Dutch clients are expected to have a harmonious, open and communicative relationship with their relatives. The American client, in contrast, is supposed to have more distant family relationships. It is argued that an interpretation of these differences in terms of ‘the right to know’ and ‘the right not to know’ misses the point, because the production of informative test results depends on the cooperation of relatives. The differences between Dutch and American practice are more adequately interpreted as implying a preference for unambiguous test results versus a preference for individual independence. The paper shows what is lost when opting for one value at the cost of another and discusses several alternatives to circumvent the value conflict at stake. By opening up for discussion the values implicit in BRCA-testing practices, the paper aims to contribute to debates on the overall desirability of these practices. [Copyright &y& Elsevier]

Nearly four in ten American use complementary or alternative medicine (CAM) each year. Even with a large number of patients, CAM practitioners face scrutiny from physicians and biomedical researchers who, in an era of evidence-based medicine, argue there is little evidence to support CAM treatments. Examining how CAM has or has not been integrated into American health care is crucial in understanding the contemporary boundaries of healthcare systems. An analytical tool from science and technology studies, boundary objects, can help scholars of medicine understand which practices become integrated into these systems. Using a comparative analysis based on archival and interview data, this paper examines the use of boundary objects in two alternative medical practices – acupuncture and Christian Science. While boundary objects alone cannot explain what health practices succeed or fail, juxtaposing the use of boundary objects by different CAM groups identifies the work boundary objects do to facilitate integration and the conditions under which they “work.” I find that acupuncturists' use of sterile needles as a boundary objects assists in their effective integration into U.S. healthcare because needles are both a symbol of biomedical prowess and a potentially unsafe device requiring regulation. Christian Scientists' use of the placebo effect as a boundary object has not succeeded because they fail to acknowledge the different contextual definitions of the placebo effect in biomedical communities. This comparative analysis highlights how context affects which boundary objects “work” for CAM practices and theorizes why alternative health practices succeed or fail to become integrated into healthcare systems. [ABSTRACT FROM AUTHOR]