Kate Seear

Technologies of hope: techniques of the online advertising of stem cell treatments

Recent media portrayals of developments in stem cell research underline the high expectations that surround this field. Trials for stem cell treatments are currently underway around the world; however, very few applications are widely available. In spite of this, a range of purported stem cell therapies are being marketed directly to patients, principally via the Internet. Scientists and clinicians have expressed concerns about the marketing of unproven treatments but responses thus far have been based upon a limited understanding of the dynamics of the advertising of such treatments. Drawing on the findings from a qualitative analysis of online, “direct-to-consumer” advertisements (DTCA) for stem cell treatments, this article examines the role played by such advertisements in the “political economy of hope.” It reveals the various techniques used by advertisers to effect a positive portrayal of treatments and thus help engender confidence in treatments and trust in providers. It concludes by discussing the implications of the findings for policy responses to the marketing of such treatments.

Rethinking safety and fidelity: The role of love and intimacy in Hepatitis C transmission and prevention

Abstract Hepatitis C (HCV) is a disease of the liver with a range of potentially debilitating symptoms, the severity of which differ from person to person. HCV is a major public health challenge. Globally an estimated one in 12 persons is affected by the virus, and substantial new transmissions occur each year. The vast majority of new transmissions occur among people who inject drugs, particularly through practices such as sharing of needles, syringes and other injecting equipment. Behavioural surveillance data suggest that the majority of equipment sharing occurs between intimate partners. Despite this, very little research has focussed on intimate partnerships as a site of hepatitis C transmission or prevention. This is in part because people who inject drugs are conventionally represented as lacking capacity for romantic love and intimacy; also, drug ‘addiction’ is produced as the antithesis of voluntarity, autonomy and authenticity, all of which feature strongly in Western understandings of romantic love. This study aims to fill existing gaps in the literature about the relationship between romantic love and injecting drug use (IDU) and to explore injecting drug practices among partners in intimate relationships. Fifteen people who inject drugs, currently in long-term heterosexual relationships, were recruited for in-depth interviews, which were recorded, transcribed verbatim and analysed thematically. The main findings of this study are that romantic love and intimacy figure prominently in the lives of people who inject drugs, and that romantic notions such as commitment, trust, care and support shape how individuals who inject drugs talk about serostatus with their partners and how they account for injecting practices. Moreover, injecting practices are co-produced within intimate relationships, shaped by perceptions of risk within and outside the relationship, ideas of intimacy, and the specific levels of skill and expertise within these relationships. These findings have important implications for harm reduction strategies, which, we suggest, have largely failed to take into account the intimate relationship as a source of practice. We conclude with suggestions for future work in this area.

Ben Cousins and the ‘double life’: exploring citizenship and the voluntarity/compulsivity binary through the experiences of a ‘drug addicted’ elite athlete

Contemporary neo-liberal public health discourse is increasingly drawn to the language of ‘addiction’. Disease models of addiction are mobilised to account for an expanding array of problematised activities, from the familiar smoking and drinking to newer candidates, such as overeating and gambling. Most models of addiction, including disease models, are underpinned by the idea that, unlike proper citizens of neo-liberal democracies, ‘addicts’ lack free will or agency. This lack can be attributed to any number of problems or dysfunctions: genetic, neurological, social or moral. One high-profile case, which challenges this approach to addiction, involves the famous Australian Rules football player Ben Cousins, one of Australias most recognised and accomplished athletes. A highly decorated player in the Australian Football League (AFL), Cousins has publicly declared himself a ‘drug addict’. In this article, we present an abridged version of an interview we conducted with Cousins around the end of his first season back in the sport (late 2009) following suspension by the AFL for ‘bringing the game into disrepute’. In the interview, we explore Cousins’ own understanding of drug ‘addiction’ and its relation to its apparent antithesis – sporting prowess. We also examine the ramifications of the ostensible paradox between drug ‘addiction’ and sporting accomplishment for understandings of ‘addiction’ as compulsivity and lack of free will. Drawing on the work of the cultural studies theorist Sedgwick (1993), we identify in Cousins’ own understandings of his drug ‘addiction’ a resistance to the absolute polarisation of voluntarity and compulsivity underpinning some of the most influential versions of the disease model of addiction. We discuss the implications of this polarisation, and of forms of resistance to it, for public health policies regarding drug addiction, and for the intersection of drug use and citizenship. Thinking through Sedgwicks alternative notion of ‘habit’, we reconsider concepts of addiction, briefly drawing in other phenomena also increasingly framed as ‘epidemics of the will’.

‘Nobody really knows what it is or how to treat it’: Why women with endometriosis do not comply with healthcare advice

This paper examines the phenomenon of non-compliance with health advice among 20 women who have been diagnosed with a chronic and incurable gynaecological condition called endometriosis. Non-compliance with health advice has been identified as a major problem in health education and behavioural literature. Constructed as a problem largely of individual patients, much research focuses upon the traits that predispose individuals to non-compliance and communication barriers to compliance. The promotion of encouragement is assumed to be an appropriate health care goal. In this paper I explore non-compliance from the perspective of the women, arguing that womens non-compliance is a form of rational expertise equivalent to scientific and medical expertise. Womens non-compliance emerges out of their subjective experiences of self-care and risk-avoidance injunctions as burdensome and excessive, as well as practically impossible, time-consuming and too expensive. Non-compliance is also motivated by a desire to avoid exposure to potential risks that can arise from compliance itself. Women also resist risk-avoidance advice on the basis of their scepticism and mistrust of doctors, whose expertise about endometriosis they doubt. This analysis contributes to our understanding of patient non-compliance and has ramifications for how health promotion and risk-avoidance campaigns are constructed and implemented, especially where chronic illnesses are concerned.

The third shift: Health, work and expertise among women with endometriosis

Abstract This paper explores the experiences of twenty Australian women living with the chronic and incurable gynaecological condition endometriosis. It examines how women become experts in their own care and the ramifications of these processes for women. Women experience patient expertise as a form of work, described here as a ‘third shift’ performed in addition to women’s paid and unpaid work. It argues that both benefits and problems flow from such work, which involves the acquisition of expertise about a chronic illness and associated processes of self-management. The central argument of this paper is that the responsibilities associated with becoming an expert endometriosis patient can both reduce and compound existing stresses for women living with this chronic illness. It concludes with some suggestions about improvements to support women living with this chronic condition.

Emergent publics of alcohol and other drug policymaking

ABSTRACT Alcohol and other drug (AOD) policy is developed within complex networks of social, economic, and political forces. One of the key ideas informing this development is that of the ‘public’ of AOD problems and policy solutions. To date, however, little scholarly attention has been paid to notions of the public in AOD policymaking. Precisely how are publics articulated by those tasked with policy development and implementation? In this article, we explore this question in detail. We analyze 60 qualitative interviews with Australian and Canadian AOD policymakers and service providers, arguing that publics figure in these interviews as pre-existing groups that must be managed – contained or educated – to allow policy to proceed. Drawing on Michael Warner’s work, we argue that publics should be understood instead as made in policy processes rather than as preceding them, and we conclude by reframing publics as emergent collectivities of interest. In closing, we briefly scrutinize the widely accepted model of good policy development, that of ‘consultation,’ arguing that, if publics are to be understood as emergent, and therefore policy’s opportunities as more open than is often suggested, a different figure – here that of ‘conference’ is tentatively suggested – may be required.

‘Standing up to the beast’: contradictory notions of control, un/certainty and risk in the endometriosis self-help literature

There have been several studies exploring the role public institutions, especially the media, play in the dissemination of information about health risks. To date, scholars have neglected the role that health self-help literature plays in risk communication. In this article, I examine how risks are constructed in self-help literature written for women with the chronic gynaecological condition endometriosis. In addition to informing readers about the risk factors associated with the disease, self-help authors suggest women can access an ‘inner power’ to avoid risks with a view to overcoming the disease. In this sense, self-help authors construct the self as both ontologically separate from and superior to the body and as capable of mastering the accidental, uncontrollable and unpredictable event of illness. Several problems with this approach are examined and it is argued that self-help books are replete with contradictory notions of certainty, uncertainty, control and risk. Endometriosis is constructed as capable of being prevented for three principal reasons: it is consistent with the neoliberal philosophy of health, the health promotion enterprise and the philosophy of the self-help movement itself, which constructs an autonomous self capable of overcoming any obstacle, including illness. I conclude that neoliberalism and self-help literature have a symbiotic relationship. Indeed, health self-help literature is the perfect tool of neo-liberalism. These findings have implications for sociological analyses of risk and health promotion, demonstrating the central role that health self-help literature plays in mediating risks and encouraging the neoliberal health promotion enterprise.

Understanding and responding to anabolic steroid injecting and hepatitis C risk in Australia: A research agenda

Abstract In recent years, several studies have suggested that the use of performance and image enhancing drugs via injection is increasing in Australia, with anabolic steroids appearing to be the most commonly used of these drugs. Traditionally the domain of elite athletes and recreational bodybuilders, steroid use may be extending to other groups, including adolescents, gym attendees, professionals and students. Like other forms of injecting drug use, steroid injecting can allow transmission of blood-borne viruses, especially hepatitis C, but little is known about how steroid injecting takes place and how such transmission might occur. Crucially, Australia’s existing harm reduction framework appears ill-equipped to deal with this emerging trend, and is underprepared to meet the challenges that it may pose. In this commentary, we outline key areas where more research into steroid use in Australia is needed. Improved understandings of the practices and experiences of individuals, who inject steroids, and the possibilities for targeted harm reduction responses, are needed if Australia is to respond to the increase in steroid use effectively.

Addiction veridiction: gendering agency in legal mobilisations of addiction discourse

ABSTRACT This paper explores the question of whether and in what ways the law and legal processes work to stabilise addiction as a health problem or ‘disease’. In undertaking this analysis, we also explore the associated gender implications of these practices and the means through which legal processes that stabilise addiction simultaneously stabilise gender. Using the work of science and technologies scholar Bruno Latour, in particular his anthropological analysis of scientific and legal ‘modes of existence’, we explore legal processes of what he calls ‘veridiction’ – or the specific processes by which law distinguishes truth from falsity – associated with addiction. We focus on processes that are largely hidden from public view and as such receive little scrutiny, but through which the meaning of addiction as a disease is secured. Our aim is to consider the role of legal negotiations in establishing agreed facts, and to explore lawyers’ understanding of these processes. We argue that although in public discourse judges are ascribed the status of the law’s key decision-making figures, lawyers’ accounts do not necessarily support this view. Instead, their accounts of the judicial process foreground their own and other lawyers’ role in decisions about addiction, despite an absence of training or education in the area. We also note that lawyers’ accounts suggest little independent oversight – even from judges – of the work lawyers do in stabilising addiction ‘facts’. Based on these observations, we consider the ways such processes of stabilisation impact on women in the legal system whose lives are in some way affected by discourses of addiction as a disease. We argue that legal practices of veridiction are centrally implicated in the making of both gender and health and that elements of these processes, which are not often publicly visible or subjected to scrutiny, require more analysis.

Making Addiction, Making Gender: A Feminist Performativity Analysis of Kakavas v Crown Melbourne Limited

Abstract This paper examines the landmark 2013 judgment of the Australian High Court in Kakavas v Crown Melbourne Limited. This case focused on the activities of Australian businessman Harry Kakavas, a regular gambler at Melbourne’s Crown casino. Kakavas argued that he was a pathological gambler unconscionably exploited by the casino. Using feminist and queer performativity theory, as well as a science and technology studies (STS) approach to the law, I explore how the court constituted gambling addiction and gender in the case. Via John Law’s notion of ‘collateral realities’, I also examine the way that legal judgments ostensibly dealing with one object can simultaneously materialise other realities, a point with relevance well beyond the present example. I conclude with reflections on the implications of this analysis for law, policy and practice in the study of addiction and gender.