In 2012, two major professional societies representing Europe and the United States released influential statements that would propel a commercial market for social egg freezing, in which women bank their oocytes for later use in order to avoid compromised fertility that comes with age. While the European Society of Human Reproduction and Embryology condoned SEF based on reproductive autonomy and justice, the American Society for Reproductive Medicine discouraged SEF based on insufficient data and concerns about false hope. In this article, (...) we map the contexts and discursive moves by which the biomedicalization of SEF proceeded since 2012. We compare professional bioethical arguments that made the case to approve SEF in Europe with news and popular media discourse that formed and shaped the commercial marketization of SEF in the United States despite the recommendation of the ASRM. While a statist pronatalist perspective informed the former, a distinctly private labor market recruitment strategy utilizing a Lean In efficiency model of feminism buttressed the latter. (shrink)

The utilization of alternative medical therapies and practitioners has increased dramatically in the U.S. in the last two to three decades. This trend seems paradoxical when one considers the rapid advances taking place in biomedical knowledge and technology during this same time period. Observers both inside and outside of the medical profession have attempted to explain the rising popularity of alternative medicine by proposing that it signals a growing sense of dissatisfaction and disenchantment with professional biomedical practices on the part (...) of the lay public. This paper challenges this thesis and offers an alternative explanation, arguing that the rise of alternative medicine is a consequence of the success and expanding influence of biomedicine rather than its failure and declining authority. The argument presented draws primarily on Ulrich Beck’s “risk society” perspective and theory of “reflexive modernization,” with specific attention to his analysis of the “reflexive scientization” process. The application of this perspective allows us to understand the emergence and development of alternative medicine as an unanticipated consequence of the process of reflexive biomedicalization in the late modern era. (shrink)

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. (shrink)

The scientific and political debate over whether a fetus can experience pain highlights a vital and controversial boundary for governance—the boundary of human life. I use the 2012 and 2013 US federal debates over twenty-week abortion bans to investigate how personhood is constructed in a society transformed by biomedical science and technology in the United States. Although those who support and oppose the bill take different stances on abortion regulation, each relies on biomedical knowledge and risk assessment to substantiate claims. (...) Through content analysis of congressional documents, I find that members of Congress strategically draw on biomedical discourse to manage the boundaries of bodies and construct a universal “at-risk” political subject in need of governmental protection. These findings bring scholarly debates about personhood into the era of biomedicalization by emphasizing the latent process of creating a hybridized subjectivity that I call cybernetic personhood. (shrink)

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. (shrink)

This article works across multiple disciplinary boundaries, especially queer theory, to examine critically the controversial, and often socially controlling, role of biomedical knowledge and interventions in the realm of human sexuality. It will attempt to situate scientific/medical discourses on sexuality historically, socially, and culturally in order to expose the ways in which “proper” sexual health in medical research and clinical practice has been conflated with prevailing social norms at particular historical junctures in the 20th and 21st centuries. How might the (...) relationship between clinical and cultural spheres be better engaged in biomedical knowledge and clinical practice in understanding sexual health, given the impact of homophobic and transphobic assumptions in the diagnostic histories of homosexuality and Gender Identity Disorder in Childhood, a new diagnostic category introduced into the DSM following the removal of homosexuality from the DSM-III? The article will argue further that biomedical knowledge is always already mediated through culture by analyzing normative racial, gender, class, and sexual ideologies that regulated early understandings of the epidemiology of the HIV/AIDS pandemic in the West and in the postcolonial world while informing global health policy on HIV/AIDS. The article concludes by examining the implications of medical education for both LGBTQI patients and medical professionals, for understanding gender and sexual rights as human rights, and for thinking about new kinds of interventions, contestations, and struggles to resist continued homophobic and transphobic assumptions in biomedical practice today and their ongoing effects in the everyday world. (shrink)

Once upon a time, an ugly duckling became famous in the history of European fairy tales. It was said of him that "… the poor duckling, who had come last out of his eggshell, and was so ugly, was bitten, pecked, and teased by both ducks and hens.… The poor thing scarcely knew what to do; he was quite distressed because he was so ugly."Today, in America—the mecca of MakeOver culture—that ugly duckling would know exactly what to do: tell his (...) pitiful tale and be accepted for an "Extreme Makeover" that would be televised around the world. This paper uses Foucault's rich and complex notion of an Apparatus to examine how weight-loss surgery is migrating into the repertoire of "normalized procedures" listed under .. (shrink)

Using a densely constructed ethnographic subject, Josephine, the “ugly duckling,” I use Foucault’s complex notion of an Apparatus to examine how Josephine’s decision to have weight-loss surgery is understandable even though it permanently destroys her normally functioning digestive system. I try to illuminate how the decision is deeply embedded in extraordinarily complex neoliberal biopolitical structures and dynamics of fat hatred camouflaged by liberatory discourses that promise “empowerment,” becoming “normal,” and discovery of her “real self.” I argue that in contemporary America, (...) Fat Hatred must be understood as a powerful systemic structure of racialized gendered oppression, that one tactic to normalize weight-loss surgery involves assimilating it to “normal” cosmetic surgery, and that Josephine must be seen, simultaneously, as legitimizing dominant obesity discourses and practices, enacting genuinely liberating personal choices, demonstrating her status as a “good American bio-citizen,” and contributing to the collective physical health and mental health of the nation since “obesity” is soon to be included in the fifth edition of the canonical Diagnostic and Statistical Manual of Mental Disorders as a mental disorder. (shrink)

The article illustrates the main features of the concept of medicalization, starting from its theoretical roots. Although it is the process of extending the medical gaze on human conditions, it appears that medicalization cannot be strictly connected to medical imperialism anymore. Other "engines" of medicalization are influential: consumers, biotechnology and managed care. The growth of research and theoretical reflections on medicalization has led to the proposal of other parallel concepts like pharmaceuticalization, genetization and biomedicalization. These new theoretical tools could (...) be useful in the analysis of human enhancement. Human enhancement can be considered as the use of biomedical technology to improve performance on a human being who is not in need of a cure: a practice that is increasingly spreading in what might be defined as a "bionic society". (shrink)

Recent findings in epigenetics have been attracting much attention from social scientists and bioethicists because they reveal the molecular mechanisms by which exposure to socioenvironmental factors, such as pollutants and social adversity, can influence the expression of genes throughout life. Most surprisingly, some epigenetic modifications may also be heritable via germ cells across generations. Epigenetics may be the missing molecular evidence of the importance of using preventive strategies at the policy level to reduce the incidence and prevalence of common diseases. (...) But while this “policy translation” of epigenetics introduces new arguments in favor of public health strategies and policy-making, a more “clinical translation” of epigenetics is also emerging. It focuses on the biochemical mechanisms and epigenetic variants at the origin of disease, leading to novel biomedical means of assessing epigenetic susceptibility and reversing detrimental epigenetic variants. In this paper, we argue that the impetus to create new biomedical interventions to manipulate and reverse epigenetic variants is likely to garner more attention than effective social and public health interventions and therefore also to garner a greater share of limited public resources. This is likely to happen because of the current biopolitical context in which scientific findings are translated. This contemporary neoliberal “regime of truth,” to use a term from Michel Foucault, greatly influences the ways in which knowledge is being interpreted and implemented. Building on sociologist Thomas Lemke's Foucauldian “analytics of biopolitics” and on literature from the field of science and technology studies, we present two sociological trends that may impede the policy translation of epigenetics: molecularization and biomedicalization. These trends, we argue, are likely to favor the clinical translation of epigenetics—in other words, the development of new clinical tools fostering what has been called “personalized” or “precision” medicine. In addition, we argue that an overemphasized clinical translation of epigenetics may further reinforce this biopolitical landscape through four processes closely related to neoliberal pathways of thinking: the internalization and isolation of socioenvironmental determinants of health and increased opportunities for commodification and technologicalization of health care interventions. (shrink)

This article examines the gamification of health applications designed to help patients manage chronic pain. Through description of one such program and in-depth interviewing, I describe why gamified pain applications are appealing to patients living with chronic pain. Individuals living with chronic pain are especially disposed to try novel pain management technologies due to the in-control and out-of-control paradox of pain (Leder, 2016). These applications are seductive not only due to this embodied phenomenon, but also because gamification taps into the (...) logic of proactive self-management that is tantamount to an era of biomedicalization, wherein subjects are incentivized to take control of their own health in the face of austerity budgets. However, pain also limits the user’s ability to adopt an immersive, lusory attitude. Thus, the speculative promises of gamified health technologies are just that – speculative, and their immersive potential should not be overstated. (shrink)

This chapter focuses on documenting the changes in life expectancy and human lifespan and reviewing current understandings of demographic and epidemiological transitions. It allows assumption of shared understandings of the meaning of human aging and old age. A key policy indicator of changes in health and life expectancy is the concept of healthy active life expectancy and associated concept of disability‐free life expectancy. From a social gerontological perspective, aging is a concept that is less contested than the idea of old (...) age. The biomedicalization of aging has been a major influence across social spaces. Vincent has described four categories of anti‐aging medicine: symptom alleviation; life expectancy extension; lifespan extension; and abolition. The development of anti‐aging technology, science, and practice challenges us to think about the enhancement of human aging and the future of later life. Attitudes to aging remain essentially negative with little evidence to suggest that institutionalized ageism will disappear. (shrink)

Family Medicine first formally confronted systems thinking with the adoption of the biopsychosocial model for understanding disease in a holistic manner; this is a description of a natural system. More recently, Family Medicine has been consciously engaged in developing itself as a system for delivering health care, an artificial system. We make this new system available to all people, whether sick or well, offering to manage not just their diseases, but their lives. However, a major difference between natural and artificial (...) systems is that natural systems have smooth feedback loops to ensures homeostasis, whereas artificial systems do not. They can only adjust themselves by disruptive adaptive and renewal cycles. Further, Family Medicine aspires to base its creation of this artificial system on the key principles of Family Medicine - continuity, comprehensiveness, and compassionate care in the context of family and community. However, there are another set of principles driving the modern Family Medicine system of healthcare, principles that function like the hidden curriculum of medical education. These principles - risk thinking, health as a commodity, and individual responsibility - are part of a deeper current within healthcare called by some biomedicalization. On closer analysis, many of these characteristics are intimately tied with liberal economies that must grow. Yet this economic system is an artificial system that lacks feedback. It is imperative that we in Family Medicine reexamine our commitment to developing artificial systems. (shrink)

It is widely argued that the final decades of the twentieth century saw a fundamental change, marked by terms such as biomedicalization and geneticization, within the biomedical sciences. What unites these concepts is the assertion that a vast array of emerging technologies—in genomics, bioengineering, information technology, and so forth—are transforming understandings of disease, diagnosis, therapeutics, and working practices. While clearly important, these analyses have been accused of perpetuating theoretical trends that attribute primacy to the new over the old, discontinuity (...) over continuity, and the laboratory over the field. In this paper, I show that in the case of autism, the effects of genomic technologies can only be understood by simultaneously examining the role of questionnaires. Due to shortcomings in clinical diagnoses, genomic analyses could only progress once questionnaires had been developed to address a “reverse salient” within the “technological system.” Furthermore, I argue that questionnaires such as the Autism Quotient have a significance that surpasses the genomic classifications they were designed to undergird. I argue that to neglect the role of mundane technologies such as questionnaires in contemporary biomedicine is to miss complexity, bifurcate old and new, and do a disservice to innovation. (shrink)

Drawing on in-depth interviews with thirty-six lesbians, this article offers a feminist qualitative analysis of lesbian conception practices. The article examines the ways lesbian actors negotiate biomedical discourse in ways that reveal the co-constitutiveness of nature and culture, bodies and technologies, and biomedical and subjective knowledge. The article offers the concept of hybrid technologies, which are described as lesbian pragmatic negotiations of shifting control loci of technoscience. The author argues that lesbians' pathways to pregnancy are characterized by a negotiation of (...) discursive elements from alternative health discourses and biomedical knowledge, of various forms of technology, and of what is often termed the authoritative, objective, and scientific with the subjugated, subjective, and the embodied. In doing so these actors complicate through multiple agencies what is often interpreted as a totalizing force of biomedicalization. (shrink)

The medicalization of mental health remains a point of contention for bioethicists, especially as it concerns the epistemic capabilities of those diagnosed with an illness or disorder. Gosselin (2019) argues that biomedicalization commits epistemic injustices against these persons and consequently entraps them in a “cycle of vulnerability”; in response, she proposes principles of justice to defend them from such affronts. This paper builds off of her work and responds particularly to the demand for a “sociocentric view of the self (...) as essentially relational.” I present a theory of interdependent agency and affiliation that I contend conceptually bolsters her normative principles. I explain how an expanded use of relational epistemologies, united with a non-ideal theory of mental health, can enrich our hermeneutical resources with respect to those with mental illnesses/disorders. My account introduces normative considerations premised on interdependency, most notably from care theory. Concepts such as vulnerability, relational autonomy, attentiveness, and responsiveness ground a relationally-situated approach that (1) improves the epistemic positionalities of patients, (2) informs more suitable dynamics of care/treatment, and (3) unites groups of mutually interested actors against harm and injustice. I thus use a framework of care to promote affiliations of similarly disadvantaged persons under shared causes and initiatives. I refer to these assemblages as “caring affinity networks.”. (shrink)

Barbados is a center of international genetic research premised on race. Drawing on ethnographic fieldwork following Johns Hopkins studies carried out in Barbados, this article explores this travel for research. This biomedical science relies on a conflicting significance of Barbados: as a site of suffering, due to the disparities of disease, and, conversely, a site of ease, playing on desires and pleasures of escaping too much asceticism in biomedicine. For the American researchers, Barbados becomes a locus of desire to ethically (...) address the African diaspora without the quandaries of accusations and recriminations experienced in carrying out such work in urban America. The concept of cathartic science is used to describe an endeavor that creates a controlled space to know and act on some perceived sufferer without risk of being complicit in the suffering. These medical migrations of researchers to Barbados are paralleled by Bajan families participating in the American studies as a kind of proxy medical migration to the US, bitterly reflecting on the care available to them at home. This article explores the motives of this mutual travel, as a biomedicalized Barbados becomes a spectral figure for patients and researchers fraught with race, injustice, and desire. The article extends the concept of cathartic science from genomics of race to medical anthropology to foreground the desires and anxieties of any science of suffering. (shrink)

A sociologist examines contemporary engagements of queer bodies and identities with fertility biomedicine. Drawing on social science, media culture, and the author’s own empirical research, three questions frame the analysis: 1. In what ways have queers on the gendered margins moved into the center and become implicated or central users of biomedicine’s fertility offerings? 2. In what ways is Fertility Inc. transformed by its own incorporation of various gendered and queered bodies and identities? And 3. What are the biosocial and (...) bioethical implications of expanded queer engagements and possibilities with Fertility Inc.? The author argues that “patient” activism through web 2.0 coupled with a largely unregulated free-market of assisted reproduction has included various queer identities as “parents-in-waiting.” Such inclusions raise a set of ethical tensions regarding how to be accountable to the many people implicated in this supply and demand industry. (shrink)

Developments in biomedical science continue to transform our understanding of concepts such as health and disease. The creation of this expertise has also had a substantive role in changing the veterinary approach to animal diseases. Traditionally, companion animal veterinarians modelled their practices on developments in the diagnosis and treatment of human patients. As science and technology have realigned the boundaries between normalcy, intra-species variation and pathology in particular domains of expertise such as orthopaedic surgery, these patterns of knowledge translation have (...) changed. Not so long ago, treatments for the rupture of the cruciate ligament in human and canine patients were based on pathoanatomical comparison and designed to reestablish the stability of the joint by the functional restoration of ligament anatomy. Recently, a radically different characterization of the canine injury—with a corresponding alternative intervention—has been proposed within the field of veterinary orthopaedics. It views the normal anatomy of the canine knee as being in some way inherently pathogenic and proposes the surgical creation of an idealized structure as a remedy to dysfunction and disease. The veterinary focus on an ideal of patient performance, rather than a specific pathology, is now influencing how orthopaedists choose to approach analogous human injuries. In this article, I chart the history of canine ‘cruciate disease’ therapies as a means to map some of the epistemic assumptions, interplays of idealized and analogical reasoning and patterns of knowledge translation central to the biomedicalization of the science and practice of orthopaedic surgery. (shrink)

In the present paper, we focus on the role that the concept of geneticization has played in the discussion about health care, bioethics and society. The concept is discussed and examples from the evolving discourse about geneticization are critically analyzed. The relationship between geneticization, medicalization and biomedicalization is described, emphasizing how debates about the latter concepts can inspire future research on geneticization. It is shown how recurrent themes from the media coverage of genetics portray typical traits of geneticization and (...) thus contribute to the process. We look at examples of small-scale studies from the literature where geneticization of medical practice has been demonstrated. Methodological disputes about the relevance of empirical evidence for the geneticization thesis and the normative status of the concept are discussed. We consider arguments to the effect that ideas from mainstream bioethics have facilitated geneticization by emphasizing individualistic notions of autonomy and responsibility while ignoring the role of genetics in the wider social context. It is shown how a concept like geneticization, which can be used to draw the attention of philosophers, social scientists and others to challenges that tend to be neglected by mainstream bioethics, also has the potential to move people’s attention away from other pertinent issues. This may happen if researchers become preoccupied with the transformative effects of genetics, and we argue that a wider reading of geneticization should inspire critical analysis of the sociocultural preconditions under which genetics is currently evolving. (shrink)

English translation by Glenn H. Shepard Jr. Revision by Matthew MeyerThis article reports on the recent “International Congress of Traditional Medicine, Interculturality, and Mental Health” held by the Takiwasi Center in Tarapoto in the Peruvian Amazon. The event united 218 researchers and indigenous and religious representatives from 22 countries to present results of scientific discussions and engage in political and ethical debates surrounding the increasingly globalized, transnational, and biomedicalized reach of indigenous medical practices, especially ayahuasca-based therapy and religious practice. The (...) author interviewed several key researchers and representatives present at the event, and presents several important controversies in the field of ayahuasca and traditional medicine. She also reports on the colorful and eclectic nonacademic sessions at the event which included Inca chiropractics, ayahuasca sessions, and various forms of indigenous medicine. The text also reflects on the tragic events that unfolded in nearby Bagua, Peru, on the evening of the meeting, bringing a special urgency to the event's focus on indigenous cultural heritage. (shrink)

Recent accounts of “the biological” emphasize its thoroughgoing transformation. Accounts of biomedicalization, biotechnology, biopower, biocapital, and bioeconomy tend to agree that twentieth- and twenty-first-century life sciences transform the object of biology, the biological. Amidst so much transformation, we explore attempts to stabilize the biological through standards. We ask: how do standards handle the biological in transformation? Based on ethnographic research, the article discusses three contemporary postgenomic standards that classify, construct, or identify biological forms: the Barcoding of Life Initiative, the (...) BioBricks Assembly Standard, and the Proteomics Standards Initiative. We rely on recent critical analyses of standardization to suggest that any attempt to attribute a fixed property to the biological actually multiplies dependencies between values, materials, and human and nonhuman agents. We highlight ways in which these biological standards cross-validate life forms with forms of life such as publics, infrastructures, and forms of disciplinary compromise. Attempts to standardize the biological, we suggest, offer a good way to see how a life form is always also a form of life. (shrink)