Ericka Johnson

Surgical simulators and simulated surgeons: reconstituting medical practice and practitioners in simulations.

Simulators that represent human patients are being integrated into medical education. This study examines the use of a haptic-enabled, virtual reality simulator designed to allow training in minimally invasive surgery (MIS) techniques. The paper shows how medical practices and practitioners are constructed during a simulation. By using the theoretical tools that situated learning and communities of practice provide, combined with the concept of reconstituting, I broaden the discussion of medical simulators from a concern with discrete skills and individual knowledge to an examination of how medical knowledge is created around and with computer simulators. The concept of reconstitution is presented as a theoretical term for understanding the interplay between simulators and people in practice. Rather than merely enacting simulator training, reconstituting creates a different context, different actors and different techniques during the simulation.

Simulating Medical Patients and Practices: Bodies and the Construction of Valid Medical Simulators

Why and how can a gynaecological simulator that has been ‘validated’ in one context, that is, accepted by experts as a functional and realistic model of the body on which to teach gynaecological exams, not be considered functional when it changes contexts and is used in another country? 1 To think through this problem, which grew out of reflections upon the ontological basis of the simulator’s different functionality within the US and Swedish contexts, I examine the use of the terms ‘reality’ and ‘validity’ in medical simulator literature, and then apply Karen Barad’s concepts of agential reality and intra-action to the gynaecological simulator’s development. This provides a new way of thinking about how knowledge can be created in and from a simulator.

Viagra Selfhood: Pharmaceutical Advertising and the Visual Formation of Swedish Masculinity

Using material from the Pfizer sponsored website providing health information on erectile dysfunction to potential Swedish Viagra customers (www.potenslinjen.se), this article explores the public image of masculinity in relation to sexual health and the cultural techniques for creating pharmaceutical appeal. We zoom in on the targeted ideal users of Viagra, and the nationalized, racialized and sexualized identities they are assigned. As part of Pfizer’s marketing strategy of adjustments to fit the local consumer base, the ways in which Viagra is promoted for the Swedish setting is telling of what concepts of masculinity are so stable and unassailable that they can withstand the association with a drug that is, in essence, an acknowledgement of ‘failed’ masculinity and ‘dysfunctional’ sexuality. With comparative national examples, this study presents an interdisciplinary take on the ‘glocalized’ cultural imaginary of Viagra, and the masculine subject positions it engenders.

The ghost of anatomies past Simulating the one-sex body in modern medical training

An examination of the use of medical simulators shows that they contain traces of the one-sex body model found in pre-Enlightenment anatomies. The simulators present the male body as ‘male including female’ rather than ‘male, not female’. Only when female sex organs are relevant to a practice, as in gynaecology, does a simulator need to become ‘female, not male’. The widely held modernist understanding of sex and gender as binary categories is actually masking local practices which allow varied sex and gender paradigms to coexist in simulator use. This analysis applies the discussions of Laqueur, Schiebinger and Faulkner to simulator practice. The consequences of recognizing the presence of the one-sex body are two-fold. Firstly, seeing that the reification of medical knowledge can still be haunted by conceptual paradigms of the past forces a more nuanced understanding of the variety that localized medical practices contain. Secondly, observing the ease with which the reified knowledge of a one-sex body is embraced by subjects who also exist in a world of binary gender points to the complexity our subjectivities can embrace and forces the researcher to acknowledge the implications of the simulations’ context.

Editorial : Post-humanities is a Feminist Issue

It is a great pleasure to introduce this special issue of NORA, entitled Posthumanities—which we construe as the conceptual re-tooling and reinvigoration of feminist research within the humanities and social sciences. Such re-tooling is here regarded as necessary so as to meet up with the accelerating changes within contemporary life engendered by technoscience (new technologies for baby-making is but one intimate example), our natural world (the climate for instance), and the discrepancies that mount up when we keep Man as the given focal point of sociocultural analysis. As has often been commented upon in recent discussions about this predicament, the deterioration of the humanities is often linked to the growing cultural and financial importance of technoscience. With this issue, in which we engage in various forms of post-humanist gender studies, we would like to make a strong case for an updated alliance between feminist theory, humanities research, and technoscience studies—an alliance that could re-calibrate the analytical tools for understanding the everyday practices of the sciences and how they affect our sense of self, while enhancing the relevance of the humanities as well as making the applicability of feminist theory more visible. As something of a transdisciplinary area of its own, feminist technoscience studies has emerged out of more than four decades of feminist materialist critiques of biological determinism and androcentric medical expertise. It is a heterogeneous field of research that takes its cues from the larger field of science and technology studies (as the study of the history and social construction of knowledge, technology, and medical practice), from actor-network theory, but also from cultural studies and post-colonial and feminist theory. Feminist technoscience studies zooms in on the ways in which gender, as it intersects with other power differentials, gives shape to and challenges technology, the medical and natural sciences, and our very understanding of nature, culture, and humanness. As humans, more obviously today than ever, are entangled in co-constitutive relations with technology and science, with other animals, and with the environment, it has become difficult to uphold notions of the human along the lines of androcentrism and anthropocentrism. This is the raison d’être for research in the registers of both post-humanities and feminist technoscience studies. In fact, feminist technoscience studies—such as the oeuvre of Donna Haraway—pioneered much of the work that today may be called post-humanities (to emphasize the transitional dimensions of the disciplines connected to the human, cultural, and natural sciences) as well as that peculiar philosophical trend of returning to (process) ontological issues as these link up with epistemological and ethical ones. Sometimes such trends are termed the material turn, or the post-human

Out of My Viewfinder, Yet in the Picture : Seeing the Hospital in Medical Simulations

This research examines the integration of medical simulators into medical education. Training on a haptic-enabled surgery simulator has been observed with an eye to the context of the medical apprenticeship. Videotape of simulations and ethnographic observations at the simulator center are analyzed using the theoretical tools of legitimate peripheral practice and identity construction. In doing so, it becomes apparent that simulations are much more than just a forum for the transfer of specific medical skills. Although they may be designed to facilitate discrete aspects of surgical practice, when in use, the simulators are surrounded by the rich and varied social interactions that make up the medical apprenticeship. These social aspects contribute to the creation of medical practices out of simulator practices, so that working on the simulator can still be experienced as part of the situated learning otherwise conducted during the internship (clinical clerkship) of medical training.

Enrolling Men, their Doctors, and Partners: Individual and Collective Responses to Erectile Dysfunction

This section of this book explores local examples of a pharmaceutical’s ability to influence the treatment of established medical conditions and redefine health problems as issues with a pharmaceut ...Using the Pfizer funded Swedish informational site about erectile dysfunction (ED), www.potenslinjen.se, we examine how potential users, their partners, and medical doctors are enrolled in the process of creating the Swedish Viagra user. Contextualized against other critical work on Viagra, our analysis shows how the commercial discourse embeds the ED patient into a network of actors. Three separate actors are co-constituted and enrolled by this erectile dysfunction information discourse, comprising Viagra marketing material in a country which forbids direct to consumer advertising of prescription medication. Doctors are enrolled to produce the cultural authority of expert medical knowledge, whereas partners are given responsibility for the emotional aspects of a man’s sexuality and encouraged to direct the man toward the relationship-saving Viagra. Throughout, though, the man is the patient responsible for taking Viagra to fix his dysfunctioning penis. We problematize this individualised solution by contrasting it with the social aspects of the discourse and examining other qualitative and historical studies of impotence. We then ask if the enrolment presented by the Swedish Viagra website could be (mis)used to expand the circle of actors involved in ED, redefi ning the ‘problem’ and opening for a wider variety of treatments.In April 2001, the Swedish government decided to immediately remove Viagra from the public pharmaceutical reimbursement system (Swedish Book of Statutes 2001, 140). All patients who still wanted th ...An exploration of how global pharmaceutical products are localized - of what happens when they become ’glocal’ - this book examines the tensions that exist between a global pharmaceutical market and the locally bounded discourses and regulations encountered as markets are created for new drugs in particular contexts. Employing the case study of the emergence, representation and regulation of Viagra in the Swedish market, Glocal Pharma offers analyses of commercial material, medical discourses and legal documents to show how a Swedish, Viagra-consuming subject has been constructed in relation to the drug and how Viagra is imagined in relation to the Swedish man.Engaging with debates about pharmaceuticalization, the authors consider the ways in which new identities are created around drugs, the redefinition of health problems as sits of pharmaceutical treatment and changes in practices of governance to reflect the entrance of pharmaceuticals to the market. With attention to ’local’ contexts, it reveals elements in the nexus of pharmaceutcalization that are receptive to cultural elements as new products become embedded in local markets.An empirically informed study of the ways in which the presence of a drug can alter the concept of a disease and its treatment, understandings of who suffers from it and how to cure it - both locally and internationally - this book will appeal to scholars of sociology and science and technology studies with interests in globalization, pharmaceuticals, gender and the sociology of medicine.The Swedish medical discourse : Impotence, erectile dysfunction and Viagra in Lakartidningen

Governing by Drugs : The Denial of Subsidy for Viagra Use in Sweden

In April of 2001, the Swedish Government decided to immediately remove Viagra from the public pharmaceutical reimbursement system (SFS 2001: 140). All patients who still wanted their use of this pharmaceutical — a treatment for erectile dysfunction (ED) — to be subsidized were henceforth required to submit individual applications for subsidy to the Government itself.1

Alpha-blockers and a weaker pharmaceutical influence on medical discourse

This section of this book explores local examples of a pharmaceutical’s ability to influence the treatment of established medical conditions and redefine health problems as issues with a pharmaceut ...Using the Pfizer funded Swedish informational site about erectile dysfunction (ED), www.potenslinjen.se, we examine how potential users, their partners, and medical doctors are enrolled in the process of creating the Swedish Viagra user. Contextualized against other critical work on Viagra, our analysis shows how the commercial discourse embeds the ED patient into a network of actors. Three separate actors are co-constituted and enrolled by this erectile dysfunction information discourse, comprising Viagra marketing material in a country which forbids direct to consumer advertising of prescription medication. Doctors are enrolled to produce the cultural authority of expert medical knowledge, whereas partners are given responsibility for the emotional aspects of a man’s sexuality and encouraged to direct the man toward the relationship-saving Viagra. Throughout, though, the man is the patient responsible for taking Viagra to fix his dysfunctioning penis. We problematize this individualised solution by contrasting it with the social aspects of the discourse and examining other qualitative and historical studies of impotence. We then ask if the enrolment presented by the Swedish Viagra website could be (mis)used to expand the circle of actors involved in ED, redefi ning the ‘problem’ and opening for a wider variety of treatments.In April 2001, the Swedish government decided to immediately remove Viagra from the public pharmaceutical reimbursement system (Swedish Book of Statutes 2001, 140). All patients who still wanted th ...An exploration of how global pharmaceutical products are localized - of what happens when they become ’glocal’ - this book examines the tensions that exist between a global pharmaceutical market and the locally bounded discourses and regulations encountered as markets are created for new drugs in particular contexts. Employing the case study of the emergence, representation and regulation of Viagra in the Swedish market, Glocal Pharma offers analyses of commercial material, medical discourses and legal documents to show how a Swedish, Viagra-consuming subject has been constructed in relation to the drug and how Viagra is imagined in relation to the Swedish man.Engaging with debates about pharmaceuticalization, the authors consider the ways in which new identities are created around drugs, the redefinition of health problems as sits of pharmaceutical treatment and changes in practices of governance to reflect the entrance of pharmaceuticals to the market. With attention to ’local’ contexts, it reveals elements in the nexus of pharmaceutcalization that are receptive to cultural elements as new products become embedded in local markets.An empirically informed study of the ways in which the presence of a drug can alter the concept of a disease and its treatment, understandings of who suffers from it and how to cure it - both locally and internationally - this book will appeal to scholars of sociology and science and technology studies with interests in globalization, pharmaceuticals, gender and the sociology of medicine.The Swedish medical discourse : Impotence, erectile dysfunction and Viagra in Lakartidningen

Glocal Pharma : International brands and the imagination of local masculinity

This section of this book explores local examples of a pharmaceutical’s ability to influence the treatment of established medical conditions and redefine health problems as issues with a pharmaceut ...Using the Pfizer funded Swedish informational site about erectile dysfunction (ED), www.potenslinjen.se, we examine how potential users, their partners, and medical doctors are enrolled in the process of creating the Swedish Viagra user. Contextualized against other critical work on Viagra, our analysis shows how the commercial discourse embeds the ED patient into a network of actors. Three separate actors are co-constituted and enrolled by this erectile dysfunction information discourse, comprising Viagra marketing material in a country which forbids direct to consumer advertising of prescription medication. Doctors are enrolled to produce the cultural authority of expert medical knowledge, whereas partners are given responsibility for the emotional aspects of a man’s sexuality and encouraged to direct the man toward the relationship-saving Viagra. Throughout, though, the man is the patient responsible for taking Viagra to fix his dysfunctioning penis. We problematize this individualised solution by contrasting it with the social aspects of the discourse and examining other qualitative and historical studies of impotence. We then ask if the enrolment presented by the Swedish Viagra website could be (mis)used to expand the circle of actors involved in ED, redefi ning the ‘problem’ and opening for a wider variety of treatments.In April 2001, the Swedish government decided to immediately remove Viagra from the public pharmaceutical reimbursement system (Swedish Book of Statutes 2001, 140). All patients who still wanted th ...An exploration of how global pharmaceutical products are localized - of what happens when they become ’glocal’ - this book examines the tensions that exist between a global pharmaceutical market and the locally bounded discourses and regulations encountered as markets are created for new drugs in particular contexts. Employing the case study of the emergence, representation and regulation of Viagra in the Swedish market, Glocal Pharma offers analyses of commercial material, medical discourses and legal documents to show how a Swedish, Viagra-consuming subject has been constructed in relation to the drug and how Viagra is imagined in relation to the Swedish man.Engaging with debates about pharmaceuticalization, the authors consider the ways in which new identities are created around drugs, the redefinition of health problems as sits of pharmaceutical treatment and changes in practices of governance to reflect the entrance of pharmaceuticals to the market. With attention to ’local’ contexts, it reveals elements in the nexus of pharmaceutcalization that are receptive to cultural elements as new products become embedded in local markets.An empirically informed study of the ways in which the presence of a drug can alter the concept of a disease and its treatment, understandings of who suffers from it and how to cure it - both locally and internationally - this book will appeal to scholars of sociology and science and technology studies with interests in globalization, pharmaceuticals, gender and the sociology of medicine.The Swedish medical discourse : Impotence, erectile dysfunction and Viagra in Lakartidningen