Antonio Maturo

The gamification of risk: how health apps foster self-confidence and why this is not enough

Weight loss apps enable users to quantify many aspects of food consumption, beginning with calories intake. Users of weight loss apps can also participate in online forums that act as digital self-help groups. These apps also include several features related to game playing or gamification such as avatars, points and virtual awards. Gamification has the aim of strengthening motivation to carry out a (boring) task. We downloaded the 20 most popular free weight loss apps in Google Play. We analysed app descriptions provided by developers, comments about the selected apps in online forums and user reviews. We focused on four of these apps, since they had some special functions. We found that users’ risk management was based on a mixed method that combined quantification and gamification, that is, rationality and emotions. Quantification, which includes self-tracking, data analysis and graphic layout, provides the ‘rational’ basis for dietary regimes, while gamification provides the emotional support needed to maintain motivation and continue with the diet. Our analysis provides support for the emotion–risk assemblage theory and the in-between strategy. Our analysis reinforces the importance of emotions in risk management. However, these dieting apps are based on a reductionist approach to obesity and weight loss, as obesity is framed as an individual problem, while weight loss is seen as dependent on individual motivation. Such framing tends to conceal the social determinant of health and the social and political causes of obesity.

Network Governance as a Response to Risk Society Dilemmas: A Proposal from the Sociology of Health

After a short description of the major sociological theories based on the concept of risk (Douglas, Beck, Luhmann, Giddens) I propose to integrate the concept of risk with the concept of trust. On a less theoretical level I propose to consider governance as the institutional response to the growing complexity of the risk society. Above all, network governance – that is institutional steering based on a high community participation – seems to give good results in the field of health care policies, as has been shown in the Emilia-Romagna area (Italy).

The Shifting Borders of Medicalization: Perspectives and Dilemmas of Human Enhancement

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.

Social Justice and Human Enhancement in Today’s Bionic Society

The use of substances that improve cognitive abilities is now more and more common in many countries. These treatments are not aimed at curing pathologies, but rather at enhancing normal human capabilities, i.e., people are using pharmaceutical products to alter their biological makeup. The following article investigates this phenomenon and questions the role of the State in relation to this practice. The article concludes with an explanation of why the State, unlike what some bioethicists have proposed, should not support the use of cognitive enhancers.

BIPOLAR DISORDER AND THE MEDICALIZATION OF MOOD: AN EPIDEMICS OF DIAGNOSIS?

Contribution to the field – In this epidemics of diagnosis of bipolar disorder it is central to integrate the medical perspective with other dimensions: the classification of mental disease, the advertisement for drugs and the cultural aspects of a given society.

I mutevoli confini della medicalizzazione: prospettive e dilemmi del miglioramento umano

I mutevoli confini della medicalizzazione: prospettive e dilemmi del miglioramento umano - 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.

Sociological Theories on Air Pollution: Between Environmental Justice and the Risk Society Approach

Risk sociologists consider risks in contemporary society to be global, interconnected, and in large part unpredictable. According to Beck, the globalization of risks implies that individuals are exposed to the same level of risk (democratization of risks). On the other hand, the environmental justice perspective, though acknowledging the centrality of risk, underlines the correlation between socio-economic inequalities and exposure to air pollution. Also, deprived people are more vulnerable to air pollution because they often have worse health conditions compared with the upper class. Promoting the involvement of lay people in research, the environmental justice perspective proposes a ‘popular epidemiology’ in contrast with the dominant trends in epidemiological perspective. Moreover, for them individual interventions based on lifestyles changes are desirable but cannot solve the problem of health threats caused by air pollution. Sociology can provide a theoretical framework, evidence from empirical research and data for both institutional forms of prevention and social mobilization against sources of pollution.

Chapter 5 The Dark Side of Digital Health

Abstract The chapter critically analyzes the concepts and the practices of surveillance in modern and postmodern societies along with their consequences. We show the changes in the systems, which are used to monitor individuals, and emphasize the transition toward soft surveillance systems, probably stimulated by digital technologies. This switch from top-down control to “lateral” monitoring systems encloses surveillance practices with suggestive names like interveillance, synopticon, and dataveillance. The dark side of digital health has a bright start. According to Topol’s (2016) vision of the future, we will soon be the “consumers,” the real protagonists, of the management of our health – thanks largely to the practically endless data about our bodies, behaviors, and lifestyles we will be able to collect and analyze. We will share our health information in real time with the doctors whom we will choose based on their score in clinical rankings (here, too, quantification rears its head). Yet, this simplified version of health makes it seem that there are always some solutions, which the algorithm can supply as long as it has enough information. Moreover, in the United States, some health-insurance companies have started to offer a discount on premiums to the members who agree to collect and share self-tracking data with them. Clearly, the discount is given only to the workers who have healthy habits. At first sight, this can seem as a win-win trade-off; however, what today is presented as an individual option can easily become a requirement tomorrow.

Chapter 3 How Apps Foster Medicalization

Abstract The biomedical paradigm enjoys growing importance in our society. Biomedicine (e.g., Genetics) seems to occupy the position once held by religion and politics. In this context, every trivial problem of daily life is thought to require an appropriate remedy, and perfect health becomes a paramount value, especially within the upper class. Medicalization is not only promoted by doctors. Today, other engines of medicalization are also available. These include pharmaceutical companies through marketing, advertising, and disease mongering; active consumers who seek a pharmacological solution – a magic bullet – to solve non-organic problems; technology, because highly sensitive diagnostic tools can now detect potential abnormalities even in very low quantities; and the culture of risk, which is connected to the evolution of diagnostic tools, because it is now always possible to be at risk of something. The parts of life today considered pathological or quasi-pathological are ever increasing shyness, sadness, imperfect blood pressure, or glucose levels. Progressing editions of the Diagnostic and Statistical Manual (DSM) – the text from which diagnoses of mental illnesses are made – reveal a growing number of syndromes. These “diseases” are diagnosed on the grounds of certain symptoms and the number of weeks they last (quantification). Smartphones, with their tremendous capacity for data collection, contribute to a growth in self-diagnoses. For example, invited to log our every moment of sadness through a “trustworthy” avatar from our app (gamification), we can easily make too much of normal moments of discomfort, immediately seeing them – with a simple computation – transformed into something pathological in need of a cure.

Chapter 6 The Positive Medicalization: Digital Meditation

Abstract In this chapter, the authors discuss the results of research carried out on a sample of students at an elite university in the northeastern United States. The focus of the research was the interpretations that the students gave to a period of digital meditation. Meditation, yoga, and mindfulness have boomed in popularity over the past few years. Several factors are responsible of our “age of anxiety.” The de-standardization of life trajectories makes people freer (at least apparently) but requires more choices and, thus, reduces the sense of security. According to Rosa (2010), anxiety has intensified due to social acceleration. Therefore, it is not surprising that we sleep less than before. However, sleep loss is not just due to stress. According to Crary (2013), capitalism produces a consumer who should be able to buy “7/24.” Consequently, the chances of consumption should not have temporal boundaries. In sum, it is not surprising that there are numerous apps to cope with anxiety. Going back to the research, one result should be mentioned: several students have used biomedical jargon to describe the effects of meditation. Someone spoke of “digital therapy” referring to meditation. Moreover, some affirmed that the perception that they had of their own body had changed; thus, they were more keen on the quantifiable aspects of bodily health. In general, students found meditation as a very useful “therapy” for a quick fix for the many stresses of college. This is why we called it a “positive” medicalization.