Biomedicalization: Technoscience, Health, and Illness in the U.S. - Brossura

Brossura

ISBN 10: 0822345706 ISBN 13: 9780822345701

Casa editrice: Duke University Press, 2010

Riassunto

The rise of Western scientific medicine fully established the medical sector of the U.S. political economy by the end of the Second World War, the first “social transformation of American medicine.” Then, in an ongoing process called medicalization, the jurisdiction of medicine began expanding, redefining certain areas once deemed moral, social, or legal problems (such as alcoholism, drug addiction, and obesity) as medical problems. The editors of this important collection argue that since the mid-1980s, dramatic, and especially technoscientific, changes in the constitution, organization, and practices of contemporary biomedicine have coalesced into biomedicalization, the second major transformation of American medicine. This volume offers in-depth analyses and case studies along with the groundbreaking essay in which the editors first elaborated their theory of biomedicalization.

Contributors. Natalie Boero, Adele E. Clarke, Jennifer R. Fishman, Jennifer Ruth Fosket, Kelly Joyce, Jonathan Kahn, Laura Mamo, Jackie Orr, Elianne Riska, Janet K. Shim, Sara Shostak

Su questo libro

Informazioni sull?autore

Adele E. Clarke is Professor of Sociology and History of Health Sciences at the University of California, San Francisco.

Laura Mamo is Associate Professor at the Health Equity Institute for Research, Practice, and Policy at San Francisco State University.

Jennifer Ruth Fosket is a principal and founder of Social Green, where she does research and writes on the intersections of health, the built environment, and sustainability.

Jennifer R. Fishman is Assistant Professor in the Social Studies of Medicine Department at McGill University.

Janet K. Shim is Assistant Professor of Sociology in the Department of Social and Behavioral Sciences at the University of California, San Francisco.

Estratto. © Ristampato con autorizzazione. Tutti i diritti riservati.

BIOMEDICALIZATION

Technoscience, Health, and Illness in the U.S.By ADELE E. CLARKE LAURA MAMO JENNIFER RUTH FOSKET JENNIFER R. FISHMAN JANET K. SHIM

DUKE UNIVERSITY PRESS

Copyright © 2010 Duke University Press
All right reserved.
ISBN: 978-0-8223-4570-1

Contents

PREFACE...........................................................................................................................................................................................................viiACKNOWLEDGMENTS...................................................................................................................................................................................................xiBIOMEDICALIZATION / A Theoretical and Substantive Introduction / Adele E. Clarke, Janet K. Shim, Laura Mamo, Jennifer Ruth Fosket, and Jennifer R. Fishman........................................................11 / BIOMEDICALIZATION / Technoscientific Transformations of Health, Illness, and U.S. Biomedicine / Adele E. Clarke, Janet K. Shim, Laura Mamo, Jennifer Ruth Fosket, and Jennifer R. Fishman.....................472 / CHARTING (BIO)MEDICINE AND (BIO)MEDICALIZATION IN THE UNITED STATES, 1890-PRESENT / Adele E. Clarke, Jennifer Ruth Fosket, Laura Mamo, Jennifer R. Fishman, and Janet K. Shim.................................883 / FROM THE RISE OF MEDICINE TO BIOMEDICALIZATION / U.S. Healthscapes and Iconography, circa 1890-Present / Adele E. Clarke......................................................................................1044 / GENDER AND MEDICALIZATION AND BIOMEDICALIZATION THEORIES / Elianne Riska......................................................................................................................................1475 / FERTILITY, INC. / Consumption and Subjectification in U.S. Lesbian Reproductive Practices / Laura Mamo........................................................................................................1736 / THE BODY AS IMAGE / An Examination of the Economic and Political Dynamics of Magnetic Resonance Imaging and the Construction of Difference / Kelly Joyce......................................................1977 / THE STRATIFIED BIOMEDICALIZATION OF HEART DISEASE / Expert and Lay Perspectives on Racial and Class Inequality / Janet K. Shim................................................................................2188 / MARKING POPULATIONS AND PERSONS AT RISK / Molecular Epidemiology and Environmental Health / Sara Shostak......................................................................................................2429 / SURROGATE MARKERS AND SURROGATE MARKETING IN BIOMEDICINE / The Regulatory Etiology and Commercial Progression of "Ethnic" Drug Development / Jonathan Kahn....................................................26310 / THE MAKING OF VIAGRA / The Biomedicalization of Sexual Dysfunction / Jennifer R. Fishman.....................................................................................................................28911 / BYPASSING BLAME / Bariatric Surgery and the Case of Biomedical Failure / Natalie Boero.......................................................................................................................30712 / BREAST CANCER RISK AS DISEASE / Biomedicalizing Risk / Jennifer Ruth Fosket..................................................................................................................................33113 / BIOPSYCHIATRY AND THE INFORMATICS OF DIAGNOSIS / Governing Mentalities / Jackie Orr..........................................................................................................................353EPILOGUE / Thoughts on Biomedicalization in Its Transnational Travels / Adele E. Clarke...........................................................................................................................380REFERENCES........................................................................................................................................................................................................407ABOUT THE CONTRIBUTORS............................................................................................................................................................................................489INDEX.............................................................................................................................................................................................................491

Chapter One

Adele E. Clarke, Janet K. Shim, Laura Mamo, Jennifer Ruth Fosket, and Jennifer R. Fishman

Biomedicalization

TECHNOSCIENTIFIC TRANSFORMATIONS OF HEALTH, ILLNESS, AND U.S. BIOMEDICINE

The growth of medicalization-defined as the processes through which aspects of life previously outside the jurisdiction of medicine come to be construed as medical problems-is one of the most potent social transformations of the last half of the twentieth century in the West (Bauer 1998; Clarke and Olesen 1999; Conrad 1992, 2000; Renaud 1995). We argue that major, largely technoscientific changes in biomedicine are now coalescing into what we call biomedicalization and are transforming the twenty-first century. Biomedicalization is our term for the increasingly complex, multisited, multidirectional processes of medicalization that today are being both extended and reconstituted through the emergent social forms and practices of a highly and increasingly technoscientific biomedicine. We signal with the "bio-" in biomedicalization the transformations of both the human and nonhuman made possible by technoscientific innovations such as molecular biology, biotechnologies, genomization, transplant medicine, and new medical technologies. That is, medicalization is intensifying, but in new and complex, usually technoscientifically enmeshed ways.

Institutionally, biomedicine is being reorganized not only from the top down or the bottom up but from the inside out. This is occurring largely through the remaking of the technical, informational, organizational, and hence the institutional infrastructures of the life sciences and biomedicine via the incorporation of computer and information technologies (Bowker and Star 1999; Cartwright 2000b; Lewis 2000; National Research Council 2000). Such technoscientific innovations are reconstituting the many institutional sites of healthcare knowledge production, distribution, and information management (e.g., medical information technologies/informatics, networked or integrated systems of hospitals, clinics, group practices, insurance organizations, the bioscientific and medical technology and supplies industries, the state, etc.). Such meso-level organizational/institutional changes are cumulative over time and have now reached critical infrastructural mass in the shift to biomedicalization.

Clinical innovations are, of course, at the heart of biomedicalization. Extensive transformations are produced through new diagnostics, treatments and procedures from bioengineering, genomics, proteomics, new computer-based visualization technologies, computer-assisted drug developments, evidence-based medicine, telemedicine/telehealth, and so on. At the beginning of the twenty-first century, such technoscientific innovations are the jewels in the clinical crown of biomedicine and vectors of biomedicalization in the West and beyond.

The extension of medical jurisdiction over health itself (in addition to illness, disease, and injury) and the commodification of health are fundamental to biomedicalization. That is, health itself and proper management of chronic illnesses are becoming individual moral responsibilities to be fulfilled through improved access to knowledge, self-surveillance, prevention, risk assessment, the treatment of risk, and the consumption of appropriate self-help and biomedical goods and services. Standards of embodiment, long influenced by fashion and celebrity, are now transformed by new corporeal possibilities made available through the applications of technoscience. New individual and collective identities are also produced through technoscience (e.g., "high-risk" statuses, DNA profiles, Syndrome X sufferers).

Biomedicalization processes are situated within a dynamic and expanding politico-economic and sociocultural biomedical sector. In this sector, the incorporation of technoscientific innovations is at once so dense, dispersed (from local to global to local), heterogeneous (affecting many different domains simultaneously), and consequential for the very organization and practices of biomedicine broadly conceived that they manifest a recorporation-a reconstitution-of this historically situated sector. We term this new social form the "Biomedical TechnoService Complex Inc." The growth of this complex since World War II is clear. The U.S. health sector has more than tripled in size over the last fifty years from 4 percent to 13 percent of GDP, and it is anticipated to exceed 20 percent by 2040 (Leonhardt 2001). At the same time, Western biomedicine has become a distinctive sociocultural world, ubiquitously webbed throughout mass culture (e.g., Bauer 1998; Lupton 1994). Health has been the site of multiple old and new social movements (e.g., Brown et al. 2001). Biomedicine has become a potent lens through which we culturally interpret, understand, and seek to transform bodies and lives. That is, if the concept of the Biomedical TechnoService Complex Inc. particularly captures some politico-economic dimensions of biomedicalization, the concept of biomedicine as a culture per se, as a regime of truth (Foucault 1980, 133), particularly captures some sociocultural dimensions.

Although we can conceptually tease apart organizational, clinical, and jurisdictional axes of change and their situatedness within a politico-economic and sociocultural sector-however vast-the ways in which these changes are simultaneous, co-constitutive, and nonfungible inform our conceptualization of biomedicalization. That is, a fundamental premise of biomedicalization is that increasingly important sciences and technologies and new social forms are co-produced within biomedicine and its related domains. Biomedicalization is reciprocally constituted and manifest through five major interactive processes: (1) the political economic constitution of the Biomedical TechnoService Complex Inc.; (2) the focus on health itself and elaboration of risk and surveillance biomedicines; (3) the increasingly technoscientific nature of the practices and innovations of biomedicine; (4) transformations of biomedical knowledge production, information management, distribution, and consumption; and (5) transformations of bodies to include new properties and the production of new individual and collective technoscientific identities. These processes operate at multiple levels as they both engender biomedicalization and are also (re)produced and transformed through biomedicalization over time. Our argument, thus, is historical, not programmatic.

We begin by examining the historical shift from medicalization to biomedicalization. We then elaborate the five key historical processes through which biomedicalization occurs. We conclude by reflecting on the implications of the shift to biomedicalization.

From Medicalization to Biomedicalization

Historically, the rise in the United States of Western (allopathic) medicine as we know it was accomplished clinically, scientifically, technologically, and institutionally from 1890 to 1945. This first "transformation of American medicine" (Starr 1982) was centered not only on the professionalization and specialization of medicine and nursing but also on the creation of allied health professions, new medico-scientific, technological, and pharmaceutical interventions, and the elaboration of new social forms (e.g., hospitals, clinics, and private medical practices) (Abbott 1988; Clarke 1988; Freidson 1970, 2001; Gaudillire and Lwy 1998; Illich 1976; Lock and Gordon 1988; Pauly 1987; Pickstone 1993; Risse 1999; Stevens 1998; and Swan 1990). Then, in the decades after World War II, medicine, as a politico-economic institutional sector and a sociocultural "good," grew dramatically in the United States through major investments, both private (industry and foundations) and public (e.g., the National Institutes of Health [NIH], Medicare, Medicaid) (Kohler 1991; NIH 1976, 2000a, 2000b). The production of medical knowledges and clinical interventions-goods and services-elaborated rapidly.

As medicine grew, sociologists and other social scientists began to attend to its importance, especially as a profession (Abbott 1988; Becker et al. 1961; Bucher 1962; Bucher and Strauss 1961; Freidson 1970; Parsons 1951; Starr 1982; Strauss et al. 1964). The concept of medicalization was framed by Irving Zola (1972, 1991) to theorize the extension of medical jurisdiction, authority, and practices into increasingly broader areas of people's lives. Initially, medicalization was seen to take place when particular social problems deemed morally problematic and often affecting the body (e.g., alcoholism, homosexuality, abortion, and drug abuse) were moved from the professional jurisdiction of the law to that of medicine. Drawing on interactionist labeling theory, Conrad and Schneider (1980) termed this a transformation from "badness to sickness." Simultaneously, some critical theorists viewed medicalization as promoting the capitalist interests of medicine and of the medical industrial complex more broadly (e.g., Ehrenreich and Ehrenreich 1978; McKinlay and Stoeckle 1988; Navarro 1986; Waitzkin 1989, 2001).

Through the theoretical framework of medicalization, medicine came to be understood as a social and cultural enterprise as well as a medico-scientific one, and illness and disease came to be understood not as necessarily inherent in any particular behaviors or conditions but as constructed through human (inter)action (Bury 1986; Lupton 2000). Further, medicalization theory also illuminated the importance of widespread individual and group acceptance of dominant sociocultural conceptualizations of medicine and active participation in its diverse, interrelated macro-, meso-, and micropractices and institutions, however uneven (Morgan 1998).

Gradually the concept of medicalization was extended to include any and all instances of new phenomena deemed medical problems under medical jurisdiction-from initial expansions around childbirth, death, menopause, and contraception in the 1970s to post-traumatic stress disorder (PTSD), premenstrual syndrome (PMS), and attention deficit hyperactivity disorder (ADHD) in the 1980s and 1990s, and so on (Armstrong 2000; Conrad 1975, 2000; Conrad and Potter 2000; Conrad and Schneider 1980a/1992; Figert 1996; Fox 1977, 2001; Halpern 1990; Litt 2000; Lock 1993; Riessman 1983; Ruzek 1978; Schneider and Conrad 1980; Timmermans 1999). Social and cultural aspects and meanings of medicalization were elaborated even further and, as we argue next, largely through technoscientific innovations. For example, conditions understood as undesirable or stigmatizable (Goffman 1963) "differences" were medicalized (e.g., unattractiveness through cosmetic surgery; obesity through diet medications), and medical treatment of such conditions was normalized (Armstrong 1995; Crawford 1985). These were the beginnings of the biomedicalization of health, in addition to illness and disease-the biomedicalization of phenomena that heretofore were deemed within the range of "normal" (Arney and Bergen 1984; Hedgecoe 2001).

Then, beginning about 1985, we suggest that the nature of medicalization itself began to change as technoscientific innovations and associated new social forms began to transform biomedicine from the inside out. Conceptually, biomedicalization is predicated on what we see as larger shifts-in-progress from the problems of modernity to the problems of late modernity or postmodernity. Within the framework of the industrial revolution, we became accustomed to "big science" and "big technology"-projects such as the Tennessee Valley Authority, the atom bomb, and electrification and transportation grids. In the current technoscientific revolution, "big science" and "big technology" can sit on your desk, reside in a pillbox or inside your body. That is, the shift to biomedicalization is a shift from enhanced control over external nature (i.e., the world around us) to the harnessing and transformation of internal nature (i.e., biological processes of human and nonhuman life-forms), often transforming "life itself." Thus it can be argued that medicalization was co-constitutive of modernity, while biomedicalization is also co-constitutive of postmodernity (Clarke 1995).

Important to the shift are the ways in which historical innovations of the medicalization era (organizational, scientific, technical, cultural, etc.) became widely elaborated and dispersed material infrastructures, resources and sociocultural discourses, and assumptions of the biomedicalization era (Clarke 1988). Biomedicalization is characterized by its greater organizational and institutional reach through the meso-level innovations made possible by computer and information sciences in clinical and scientific settings, including computer-based research and record keeping. The scope of biomedicalization processes is thus much broader and includes conceptual and clinical expansions through the commodification of health, the elaboration of risk and surveillance, and innovative clinical applications of drugs, diagnostics, and treatment procedures. This includes the production of new social forms through "dividing practices" that specify population segments such as risk groups (Rose 1994). These groups are to be given special attention through new "assemblages" (Deleuze and Guattari 1987) of spaces, persons, and techniques for caregiving. Innovations and interventions are not administered only by medical professionals but are also "technologies of the self," forms of self-governance that people apply to themselves (Foucault 1988; Rose 1996). Such technologies pervade more and more aspects of daily life and the lived experience of health and illness, creating new biomedicalized subjectivities, identities, and biosocialities-new social forms constructed around and through such new identities (Rabinow 1992). We seek to capture these changes in the ordering of health-related activities and the administration of individuals and populations-including self-administration-referred to as governmentality.

The table offers an overview of the shifts from medicalization to biomedicalization cobbled and webbed together through the increasing application of technoscientific innovations. One overarching analytic shift is from medicine exerting clinical and social control over particular conditions to an increasingly technoscientifically constituted biomedicine also capable of effecting the transformation of bodies and lives (Clarke 1995). Such transformations range from life after complete heart failure, to walking in the absence of leg bones, to giving birth a decade or more after menopause, to the capacity to genetically design life itself-vegetable, animal, and human. Of course, many biomedically induced bodily transformations are much less dramatic, such as Botox and laser eye surgery, but these are no less technoscientifically engineered.

The rest of the table describes shifts from medicalization to biomedicalization within the five key processes that co-constitute biomedicalization. Analytically, the shift from medicalization to biomedicalization occurs unevenly across micro, meso, and macro levels. Significantly, biomedicalization theory emphasizes organizational/institutional meso-level changes, and these are highlighted here in order to describe the processes and mechanisms of action and change in concrete-if widespread-practices. Biomedicalization is constituted through the transformation of the organization of biomedicine as a knowledge-and technology-producing domain as well as one of clinical application. Computer and information technologies and the new social forms co-produced through their design and implementation are the key infrastructural devices of the new genres of mesoinstitutionalization (Bowker and Star 1999). The techno-organizational innovations of one era become the (often invisible) infrastructures of the next (Clarke 1988, 1991).

The following points are at the core of our argument about the shift from medicalization to biomedicalization. We offer an alternative understanding of historical change beyond that of technological determinism (e.g., Jasanoff 2000; Rose 1994). While we see sciences and technologies as powerful, we do not see them as determining futures. With other science, technology, and medicine studies scholars, we start with the assumption that sciences and technologies are made by people and things working together (e.g., Latour 1987; Clarke 1987). Human action and technoscience are co-constitutive, thereby refuting technoscientific determinisms (Smith and Marx 1994). Although the changes wrought by biomedicalization are often imaged as juggernauts of technological imperatives (Koenig 1988), bearing distinctive Western biomedical assumptions (Lock and Gordon 1988; Tesh 1990), the new social/cultural/economic/organizational/institutional forms routinely produced as part and parcel of technoscientific innovations are usually analytically ignored (Vaughan 1996, 1999). That is, the realms and dynamics of the social inside scientific, technological, and biomedical domains are too often rendered invisible. At the heart of our project lie the tasks of revealing these new social forms and opening up critical spaces to allow greater democratic participation in shaping human futures with technosciences.

Therefore, central to our argument is the point that in daily material practices, biomedicalization processes are not predetermined but quite contingent (Freidson 2001; Olesen 2002; Olesen and Bone 1998). In laboratories, schools, homes, and hospitals today, workers and people as patients and as providers/health system workers are responding to and negotiating biomedicalization processes, attempting to shape new technoscientific innovations and organizational forms to meet their own needs (Strauss, Schatzman, et al. 1964; Wiener 2000). In practice, the forces of biomedicalization are at once furthered, resisted, mediated, and ignored as varying levels of personnel respond to their constraints and make their own pragmatic negotiations within the institutions and in the situations in which they must act (Lock and Kaufert 1998; Morgan 1998; Olesen 2000; Smith 1997). As a result, the larger forces of biomedicalization are shaped, deflected, transformed, and even contradicted.

(Continues...)

Excerpted from BIOMEDICALIZATIONby ADELE E. CLARKE LAURA MAMO JENNIFER RUTH FOSKET JENNIFER R. FISHMAN JANET K. SHIM Copyright © 2010 by Duke University Press. Excerpted by permission.
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Dettagli dell'edizione

• Editore: Duke University Press
• Data di pubblicazione: 2010
• Lingua: Inglese
• ISBN 10: 0822345706
• ISBN 13: 9780822345701
• Rilegatura: Copertina flessibile
• Numero di pagine: 512
• Redattore: Clarke
• Contatto del produttore: non disponibile
• Persona responsabile: gpsr@libri.de; gpsr@libri.de; ; Friedensallee 273; Hamburg; 22763; Germania