Adele E. Clarke

Biomedicalization: Technoscientific Transformations of Health, Illness, and U.S. Biomedicine

The first social transformation of American medicine institutionally established medicine by the end of World War II. In the next decades, medicalization-the expansion of medical jurisdiction, authority, and practices into new realms-became widespread. Since about 1985, dramatic changes in both the organization and practices of contemporary biomedicine, implemented largely through the integration of technoscientific innovations, have been coalescing into what the authors call biomedicalization, a second transformation of American medicine. Biomedicalization describes the increasingly complex, multisited, multidirectional processes of medicalization, both extended and reconstituted through the new social forms of highly technoscientific biomedicine. The historical shift from medicalization to biomedicalization is one from control over biomedical phenomena to transformations of them. Five key interactive processes both engender biomedicalization and are produced through it: (1) the political economic reconstitution of the vast sector of biomedicine; (2) the focus on health itself and the elaboration of risk and surveillance biomedicines; (3) the increasingly technological and scientific nature of biomedicine; (4) transformations in how biomedical knowledges are produced, distributed, and consumed, and in medical information management; and (5) transformations of bodies to include new properties and the production of new individual and collective technoscientific identities.

Disciplining reproduction : modernity, American life sciences, and "the problems of sex"

This volume traces the complicated paths through which physiological approaches to reproduction led to endocrinological approaches, creating along the way new technoscientific products from contraceptives to hormone therapies to new modes of assisted conception - for both humans and animals. The author focuses on the changing relations and often uneasy collaborations among scientists and the key social worlds most interested in their work - major philanthropists and a wide array of feminist and medical birth control and eugenics advocates - and recounts how the reproductive sciences slowly acquired standing.

The Many Faces of RU486: Tales of Situated Knowledges and Technological Contestations

In the highly contentious abortion arena, the new oral abortifacient technology RU486 is one among many actors. This article offers an arena analysis of the heterogeneous constructions of RU486 by various actors, including scientists, pharmaceutical compa nies, medical groups, antiabortion groups, womens health movement groups, and others who have produced situated knowledges. Conceptually, we find not only that the identity of the nonhuman actor-RU486 -is unstable and multiple but also that, in practice, there are other (previously invisible) implicated actors—the downstream users and consumers of the technology. If we try to follow all the actors, we find a fuller and more historicized arena, and, ironically, we too can be construed as implicated actors in it.

Medicalization and Biomedicalization Revisited: Technoscience and Transformations of Health, Illness and American Medicine

Medicalization theory has been at the heart of medical sociology or the sociology of health and illness for nearly 40 years (Zola 1972; Freidson 1970) and is also vital to medical anthropology (Hogle 2002; Lock 2001, 2004), the history of medicine (Nye 2003; Sinding 2004), medicine itself (Chervenak and McCullough 2005), bioethics (Bergeron 2007), and beyond. The still robust medicalization thesis is that the legitimate jurisdiction of Western or scientific medicine began expanding by including new domains of human life (such as alcoholism, drug addiction, and obesity) by redefining or reconstructing them as falling properly within medical (rather than legal, religious, etc.) domains (e.g., Ballard and Elston 2005; Conrad 1992, 2005, 2007; Conrad and Schneider 1980a, b).

Transposing bodies of knowledge and technique: animal models at work in reproductive sciences

A prominent feature of biological and biomedical research and therapeutics over the past century is the entanglement of human and other animal bodies in the making and remaking of knowledge, techniques and products. In this paper, we explore how animal models work in two different but interrelated situations: early/mid 20th-century reproductive sciences focused on human biomedicine; and early 21st-century assisted reproduction of endangered animals in zoos. We use the concept of ‘transposition’ to describe and compare how findings about different species, the infrastructures supporting different species and the body parts of different animal species have been mobilized at these sites. We show how such mobilizations create dynamic relationships in organizational, discursive and embodied ways. The two case studies illuminate the changing practices of modelling within the reproductive sciences, and the changing kinds of work animal models have done in those fields.

The traffic in cyberanatomies: sex/gender/sexualities in local and global formations

Medical anatomy is one of the key sites of the scientific production, reproduction and maintenance of sex and gender. Our Human Anatomies Project explores the construction, reconstruction and maintenance of difference in genital anatomies, focusing especially on the clitoris. This article focuses on representations of human genitalia in the form of cyberanatomies - video, CD-ROM and internetbased renderings of human bodies. In cyberspace as elsewhere, the biomedical expert remains the proper and dominant mediator between humans and their own bodies, despite the democratization of knowledges supposedly possible through the Internet. Special attention is given to the specific sites of production and distribution of these different cyberanatomies. Through our review of the globalization of cyberanatomies, we have come to witness the very sedimentation of sex/gender/sexuality in new arenas of representations of human bodies. Western biomedical imperialism and globalization of a standardized (American) body are taken up as core theoretical concerns.

In Memoriam: Susan Leigh Star (1954-2010)

Corresponding Author: Adele E. Clarke, Department of Social and Behavioral Sciences, Box 0612 UC San Francisco, Laurel Heights Campus, 3333 California Street, Suite 455, San Francisco, CA 94143-0612 Email: Adele.Clarke@ucsf.edu Science, Technology, & Human Values 35(5) 581-600 a The Author(s) 2010 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0162243910378096 http://sthv.sagepub.com

Medicalizzazione e biomedicalizzazione rivisitate: tecno-scienze e trasformazioni di salute, malattia e biomedicina

Medicalizzazione e biomedicalizzazione rivisitate: tecno-scienze e trasformazioni di salute, malattia e biomedicina - In this article, we review the history of medicalization theory and then offer a historicized definition of biomedicalization. We consider the relationships between biomedicalization and other contemporary theorizing, seeking in particular to situate the concept explicitly in relation to recent scholarship on the politics of life itself. We discuss how biomedicalization processes dovetail with such politics of life as they are engaged individually, collectively, and at the level of population, including issues of bioeconomy, biocapital, citizenship and enhancement. We then address and respond to several critiques of biomedicalization theory, that question its newness, omnipresence, and determinism. In conclusion, we discuss the relations among medicalization, biomedicalization and medical sociology and offer directions for future research. Keywords: biomedicalization, medicalization, technoscience, health, politics of life, optimization. Parole chiave: biomedicalizzazione, medicalizzazione, tecnoscienza, salute, politica della vita, ottimizzazione.

The Aboriginal Australian Family Wellbeing Program: A Historical Analysis of the Conditions That Enabled Its Spread

Introduction Spreading proven or promising Aboriginal health programs and implementing them in new settings can make cost-effective contributions to a range of Aboriginal Australian development, health and wellbeing, and educational outcomes. Studies have theorized the implementation of Aboriginal health programs but have not focused explicitly on the conditions that influenced their spread. This study examined the broader political, institutional, social and economic conditions that influenced negotiations to transfer, implement, adapt, and sustain one Aboriginal empowerment program—the Family Wellbeing (FWB) program—to at least 60 geographical sites across Australia over 24 years. Materials and methods A historical account of the spread of the FWB Program was constructed using situational analysis, a theory-methods package derived from a poststructural interpretation of grounded theory methods. Data were collected from published empirical articles, evaluation reports and project articles, and interviews with 18 key actors in the spread of FWB. Social worlds and arenas maps were used to determine the organizations and their representative agents who were involved in FWB spread and to analyze the enabling and constraining conditions. Results The program was transferred through three interwoven social arenas: employment and community development; training and capacity development; and social and emotional wellbeing promotion and empowerment research. Program spread was fostered by three primary conditions: government policies and the availability and Aboriginal control of funding and support; Aboriginal leadership, associated informal networks and capability; and research evidence that built credibility for the program. Discussion and conclusion The continued demand-driven transfer of empowerment programs requires policies that enable Aboriginal control of funding and Aboriginal leadership and networks. Flexible and sustained coordination of program delivery is best leveraged through regional innovation hubs that can work with partner organizations to tailor the program to local end-user needs. Associated research is also needed to evaluate, continually improve program quality, and build program credibility through evidence.

Commentary on Celia Iriart and Emerson Elias Merhy: “Inter-capitalistic disputes, biomedicalization and hegemonic medical model”

“Inter-capitalistic disputes, biomedicalization and hegemonic medical model”Comentarios sobre o texto de Iriart e Merhy: “Disputas inter-capitalistas, biomedicalizacao e modelo medico hegemonico”Comentarios sobre el texto de Iriart y Merhy: “Disputas inter-capitalistas, biomedicalizacion y modelo medico hegemonico”