Claire Tanner

Between hope and evidence: how community advisors demarcate the boundary between legitimate and illegitimate stem cell treatments.

Stem cell science provides an exemplary study of the ‘management of hope’. On the one hand, raising ‘hopes’ and expectations is a seen as a necessary aspect of securing investment in promising innovative research. On the other, such hyperbole risks raising hopes to a level that may lead people to undertake undue risks, which may ultimately undermine confidence in medical research. In this context, the ‘management of hope’ thus involves the negotiation of competing claims of truth about the value and safety of particular treatments and about the trustworthiness of providers. Using Gieryn’s concept of boundary-work, this article examines the means by which this work of ‘managing hope’ is undertaken. Drawing on data collected as part of our study that investigated the perspectives of those who are consulted by patients and their carers about stem cell treatments, we explore how these community advisors – both scientists and clinicians with a stake in stem cell research and representatives from patient advocacy groups – demarcate the boundary between legitimate and illegitimate treatments. In particular, we examine how these actors rhetorically use ‘evidence’ to achieve this demarcation. We argue that analysing accounts of how advisors respond to patient enquiries about stem cell treatments offers a window for examining the workings of the politics of hope within contemporary bioscience and biomedicine. In conclusion, we emphasize the need to re-conceptualize the boundary between science and non-science so as to allow a better appreciation of the realities of health care in the age of medical travel.

Social class, anxieties and mothers' foodwork.

In the context of concerns about childhood obesity, mothers are placed at the forefront of responsibility for shaping the eating behaviour and consequently the health of their young children. This is evident in a multitude of diverse sites such as government reports, health promotion materials, reality TV shows and the advice of childcare nurses and preschools. These sites produce a range of resources available to mothers to draw on to constitute themselves as mothers in terms of caring for their childrens health. Drawing on a qualitative study of mothers recruited through three Australian preschool centres, this article examines how the working-class and middle-class mothers of preschool-aged children engage with knowledge about motherhood, children and health and how those engagements impact on their mothering, their foodwork and their children. We argue that, unlike the working-class mothers pathologised in some literature on obesity, these working-class mothers demonstrated a no-nonsense (but still responsibilised) approach to feeding their children. The middle-class mothers, on the other hand, were more likely to engage in practices of self-surveillance and to demonstrate considerable anxieties about the appropriateness of their practices for their childrens current and future health.

'My dirty little habit': patient constructions of antidepressant use and the ‘crisis’ of legitimacy

Discontents surrounding depression are many, and include concerns about a creeping appropriation of everyday kinds of misery; divergent opinions on the diagnostic category(ies); and debates about causes and appropriate treatments. The somewhat mixed fortunes of antidepressants - including concerns about their efficacy, overuse and impacts on personhood - have contributed to a moral ambivalence around antidepressant use for people with mental health issues. Given this, we set out to critically examine how antidepressant users engage in the moral underpinnings of their use, especially how they ascribe legitimacy (or otherwise) to this usage. Using a modified constant comparative approach, we analyzed 107 narrative interviews (32 in UKa, 36 in UKb, 39 in Australia) collected in three research studies of experiences of depression in the UK (2003-4 UKa, and 2012 UKb) and in Australia (2010-11). We contend that with the precariousness of the legitimacy of the pharmaceutical treatment of depression, participants embark on their own legitimization work, often alone and while distressed. We posit that here, individuals with depression may be particularly susceptible to moral uncertainty about their illness and pharmaceutical interventions, including concerns about shameful antidepressant use and deviance (e.g. conceiving medication as pseudo-illicit). We conclude that while peoples experiences of antidepressants (including successful treatments) involve challenges to illegitimacy narratives, it is difficult for participants to escape the influence of underlying moral concerns, and the legitimacy quandary powerfully shapes antidepressant use.

Vanity: 21st century selves.

It has become something of a cliche that Western culture is obsessed with celebrity, glamour, and the opportunities ordinary people are now given (reality television, social networking sites, blogging) to become famous. These new engagements between fame and obscurity have been accompanied by energetic debates about the self, image and vanity. Similar debates are also underway in a domain apparently quite different from this digital realm – the corporeal domain of health, fitness, beauty and anti-ageing. Vanity, it seems, can account for both our least and most bodily modes of making the self. Despite these growing areas of debate, little or no sociological or cultural studies research on vanity has been conducted to date. This book sets out to remedy this. Exploring a range of sites of social and cultural production – from Helen Mirrens red bikini to The Biggest Loser reality weight loss show, from suffragists to Viagra, from anti-ageing medicine to Facebook – the book takes an engaging, sophisticated and wide-ranging look at new ideas and practices of vanity. How are contemporary subjects to cope with concurrent pressures both towards self-absorption and away from it? Taking an explicitly gendered approach to these questions, Vanity: 21st Century Selves conducts a broad analysis of a key concept shaping contemporary Western societies and their ways of understanding the self.

University students’ drinking as a social practice and the challenge for public health

Abstract In this paper, we explore the relational dynamics of alcohol consumption by university students, drawing on qualitative interviews with fifty undergraduates in Victoria, Australia. We argue that university drinking is a social practice comprised of a bundle of activities that operate together to reinforce excessive consumption. Drawing on a distinct version of social practice theory, we conceptualise drinking as an organising principle of university social life with interacting elements – meanings, materials and competences. The meanings of drinking include cultural conventions, expectations and socially shared meanings that alcohol is central to student life. Materials of drinking include objects and infrastructures such as, beverage choice, drinking venues and mobile phones. Drinking competences include managing bodily effects of alcohol but also social relationships while consuming alcohol. The distinct social practice perspective we utilise can assist public health to address the interrelated dynamics of alcohol consumption as a social practice, with its own trajectory into which students are recruited and become carriers of the practice while at university.

Practicing Food Anxiety: Making Australian Mothers Responsible for Their Families’ Dietary Decisions

Concerns about the relationship between diet, weight, and health find widespread expression in the media and are accompanied by significant individual anxiety and responsibilization. However, these pertain especially to mothers, who undertake the bulk of domestic labor involved in managing their families’ health and wellbeing. This article employs the concept of anxiety as social practice to explore the process whereby mothers are made accountable for their families’ dietary decisions. Drawing on data from an Australian study that explored the impact of discourses of childhood obesity prevention on mothers, the article argues that mothers’ engagements with this value-laden discourse are complex and ambiguous, involving varying degrees of self-ascribed responsibility and blame for childrens weight and diets. We conclude by drawing attention to the value of viewing food anxiety as social practice, in highlighting issues that are largely invisible in both official discourses and scholarly accounts of childhood obesity prevention.

Starting antidepressant use: A qualitative synthesis of UK and Australian data

Objective To explore peoples experiences of starting antidepressant treatment. Design Qualitative interpretive approach combining thematic analysis with constant comparison. Relevant coding reports from the original studies (generated using NVivo) relating to initial experiences of antidepressants were explored in further detail, focusing on the ways in which participants discussed their experiences of taking or being prescribed an antidepressant for the first time. Participants 108 men and women aged 22–84 who had taken antidepressants for depression. Setting Respondents recruited throughout the UK during 2003–2004 and 2008 and 2012–2013 and in Australia during 2010–2011. Results People expressed a wide range of feelings about initiating antidepressant use. Peoples attitudes towards starting antidepressant use were shaped by stereotypes and stigmas related to perceived drug dependency and potentially extreme side effects. Anxieties were expressed about starting use, and about how long the antidepressant might begin to take effect, how much it might help or hinder them, and about what to expect in the initial weeks. People worried about the possibility of experiencing adverse effects and implications for their senses of self. Where people felt they had not been given sufficient time during their consultation information or support to take the medicines, the uncertainty could be particularly unsettling and impact on their ongoing views on and use of antidepressants as a viable treatment option. Conclusions Our paper is the first to explore in-depth patient existential concerns about start of antidepressant use using multicountry data. People need additional support when they make decisions about starting antidepressants. Health professionals can use our findings to better understand and explore with patients’ their concerns before their patients start antidepressants. These insights are key to supporting patients, many of whom feel intimidated by the prospect of taking antidepressants, especially during the uncertain first few weeks of treatment.

Seeing the Full Picture: The Hidden Cost of the Stem Cell and Regenerative Medicine Revolution

In recent decades, significant time, money and energy have been invested in the attempt to harness the regenerative power of stem cells to ameliorate the pain and suffering in a wide range of illnesses and injuries—from autoimmune disorders, congenital diseases and degenerative neurological conditions to acquired brain and spinal cord injuries. Here stem cells are often posited as a ‘holy grail’ with magical powers just waiting to be unlocked or revealed to the world through the toil and labour of those pioneers at the cutting edge of research. It is in this heightened context of anticipation and expectation that significant investments are also made by those on the other side of the bench; the people and their loved ones seeking help for the conditions and illnesses with which they live and die. For some, this investment involves at least considering, and often travelling to receive, experimental stem cell treatments (SCTs). Drawing on qualitative interviews with patients and carers who have made these journeys, this chapter offers a complex and contextualised picture for better understanding and responding to the needs of the increasing numbers of people considering or travelling overseas or within their own country for experimental SCTs.

‘Choice’, Hope, and Stem Cell Treatments

As perhaps the most visible aspect of an increasingly global healthcare market, medical tourism would seem to epitomise the ‘consumer choice’ of free-market capitalism and everything that is seen to entail—namely, self-determination via freedom to decide treatments and travel, freedom of mobility, and the consumption of products and services that are ‘personalised’. In societies governed by neoliberal philosophies and policies, ‘freedom of choice’ has strong appeal, suggesting the absence of personal constraint or self-control over one’s circumstances and destiny. But what does ‘choice’ mean for patients and their carers in contexts where there are few or no clinically proven treatment options available to them, or where options that are presented are perceived as equally undesirable or unaffordable?

Anti-Ageing Medicine and the Consumption of Youth

Zygmunt Bauman (2007) has argued that newness is the key value of a consuming society. For Bauman, practices of discarding the old and turning to the new are central to the configuration of contemporary lives. These practices encompass bodies too, as ‘bodies are, simultaneously, promoters of commodities and the commodities they promote’ (Bauman, 2007, p. 6, emphasis in original). Sander Gilman has argued in his influential book on beauty making the body beautiful (1999) that the fight against ageing is a crucial arena in which individual success is measured in Western societies. The contemporary emphasis on the ‘healthy body’ as the responsibility and right of every individual has been extended to the management of the processes and practices of ageing. Commonly deployed cultural concepts such as the disjunction between ‘biological’ and ‘chronological’ age suggest that bodies can be made younger. The difference between how old we ‘feel’ we are and our actual age, captured in the common maxim ‘50 is the new 40’, is now presented as a gap that can be elided. Instead of accepting a process of inevitable decline, we are invited to achieve or maintain a youthful body. The decisions and choices we make about health practices and beauty or cosmetic practices can either contribute to ageing or arrest it.