Harmless,friendly and lethal: antibiotic misuse in relation to the unpredictable bacterium Group A streptococcus

Evidence‐based treatment guidelines for managing infections in health care are promoted as tools to prevent unnecessary use of antibiotics. Antibiotic misuse has been examined as regards the doctor‐patient relation and the social context of medical practice. Less attention has been paid to how the very conceptualisation of human‐microbial relations may influence understandings of antibiotic misuse. The article examines a medical controversy concerning guidelines for managing throat infection and antibiotic treatment in Sweden. It demonstrates how this controversy unfolds around two different ways of relating to a specific bacterium – Group A Streptococcus. The analysis shows how two ‘microbiopolitics’, involving different understandings of human‐microbial relations, are created in the controversy and how different antibiotic prescribing practices are justified. By focusing on Group A Streptococcus, which is commonly observed, but also unpredictable and potentially dangerous, the article provides new insights into the relations between bacteria, humans and policy in an age of antimicrobial resistance. It argues, in particular, that the definition of antibiotic misuse is unstable and consequently that policy measures aimed at reducing misuse must be related to how specific infections and bacteria are conceptualised in the actual context the policy addresses.     

Exploring parkrun as a social context for collective health practices: running with and against the moral imperatives of health responsibilisation

Critiques of public health policies to reduce physical inactivity have led to calls for practice‐led research and the need to reduce the individualising effects of health promotion discourse. The purpose of this paper is to examine how parkrun – an increasingly popular, regular, community‐based 5 km running event – comes to be understood as a ‘health practice’ that allows individuals to enact contemporary desires for better health in a collective social context. Taking a reflexive analytical approach, we use interview data from a geographically diverse sample of previously inactive parkrun participants (N = 19) to explore two themes. First, we argue that parkrun offers a space for ‘collective bodywork’ whereby participants simultaneously enact personal body projects while they also experience a sense of being ‘all in this together’ which works to ameliorate certain individualising effects of health responsibilisation. Second, we examine how parkrun figures as a health practice that makes available the subject position of the ‘parkrunner’. In doing so, parkrun enables newly active participants to negotiate discourses of embodied risk to reconcile the otherwise paradoxical experience of being an ‘unfit‐runner’. Findings contribute to sociological understandings of health and illness through new insights into the relation between health practices and emerging physical cultures, such as parkrun.     

Two regimes of HIV/AIDS: The MMWR and the socio‐political construction of HIV/AIDS as a ‘black disease’

Over the course of the HIV/AIDS epidemic, black Americans have become a central target of US public health prevention efforts. And today, HIV/AIDS is understood to disproportionately affect black Americans. This markedly contrasts with knowledge about the disease and efforts to prevent it in the first decade of the epidemic in the US, when expert and lay understandings and responses centred on white gay males. This article demonstrates that explaining these historical reversals as purely reflective of epidemiological data – or best knowledge available – is insufficient. Drawing on the concept disease regimes and utilising a discursive analysis of epidemiological results and editorial commentary published from 1981 to 1994 in the Morbidity and Mortality Weekly Reports (MMWR), this article argues for a socio‐political explanation for the changing colour of HIV/AIDS. That is, it scrutinises institutional and discursive practices that within the HIV/AIDS prevention field and disease discourse constituted a ‘regime of black American exclusion’ (1981–1992) and a ‘regime of black American inclusion (1993–present day).     

Genomic expertise in action: molecular tumour boards and decision‐making in precision oncology

The recent development of cancer precision medicine is associated with the emergence of ‘molecular tumour boards’ (MTBs). Attended by a heterogenous set of practitioners, MTBs link genomic platforms to clinical practices by establishing ‘actionable’ connections between drugs and molecular alterations. Their activities rely on a number of evidential resources – for example databases, clinical trial results, basic knowledge about mutations and pathways – that need to be associated with the clinical trajectory of individual patients. Experts from various domains are required to master and align diverse kinds of information. However, rather than examining MTBs as an institution interfacing different kinds of expertise embedded in individual experts, we argue that expertise is the emergent outcome of MTBs, which can be conceptualised as networks or ‘agencements’ of humans and devices. Based on the ethnographic analysis of the activities of four clinical trial MTBs (three in France and an international one) and of two French routine‐care MTBs, the paper analyses how MTBs produce therapeutic decisions, centring on the new kind of expertise they engender. The development and activities of MTBs signal a profound transformation of the evidentiary basis and processes upon which biomedical expertise and decision‐making in oncology are predicated and, in particular, the emergence of a clinic of variants.     

Moving towards relationship‐based practices in a crisis nursery setting

Recent theory and research suggest that effective services for children and families should take a relationship‐based perspective, with an emphasis on parent–child relationships as the central context for children’s development. This may be especially hard to achieve in agencies such as crisis nurseries, where interactions with families and children may be primarily short‐term and crisis‐oriented. This article describes the 18‐month ‘Relationships Project’, developed and implemented in one crisis nursery to infuse relationship‐based understandings and practices into its two service areas, crisis child care services and family services. The project drew upon an existing relationship‐based model to make the vision of a relationship‐based organisation obvious and learnable, and to use underlying principles as organisers for achieving cohesiveness in knowledge and in practice. The article describes this change process, perspectives of participants and lessons learned.     

Major new review of global evidence on diet,nutrition and physical activity: A blueprint to reduce cancer risk

The number of cancer cases is increasing. Despite advances in treatment, cancer causes one in six deaths worldwide and has overtaken cardiovascular disease as the leading cause of death in many parts of the world. Yet around 40% of cancer cases are preventable through lifestyle changes. The newly published Third Expert Report, Diet, Nutrition, Physical Activity and Cancer: A Global Perspective, from World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR), provides a comprehensive analysis of the worldwide body of evidence on preventing and surviving cancer through diet, nutrition and physical activity. Using the most meticulous methods, evidence from studies on 17 cancers and 51 million people – including 3.5 million cancer cases – has been reviewed. The findings have been used to produce the latest global Cancer Prevention Recommendations – which together form a blueprint to prevent cancer that people can trust – and to identify priority areas for future research. The Report, summarised in this article, ensures that people are equipped with the knowledge needed to prioritise cancer prevention – be they researchers, medical or health professionals, policymakers, civil society organisations (including cancer organisations), the media or people looking to reduce their own risk of cancer or live well after a diagnosis. A whole‐of‐government, whole‐of‐society approach is necessary to create environments for people and communities that are conducive to following the WCRF/AICR Recommendations in order to reduce the number of deaths from preventable cancer.     

Translating critical public health

One of the abiding challenges of engaging critically with public health practice is speaking across disciplinary lines. I ask critical public health scholars to consider the technologies and practices that may render their ideas inaccessible to others, while also exploring the importance of retaining those practices. I propose that if critical scholars must take seriously health promotion’s focus on knowledge translation (KT) to rethink their own forms of communication, they will need to find strategies for doing so without compromising key aspects of their work. Although KT is praised for its paradigm-shifting break from knowledge transfer, it still involves conceptualizing knowledge as a commodity to be packaged for application. Nonetheless, a creative engagement with KT may be possible. Drawing on Emily Apter’s complementary and contradictory theses – ‘Nothing is translatable’ (xi) and ‘Everything is translatable’ (xii) – I suggest a new direction for thinking through the impossible and imperative task of translating critical public health scholarship.     

Operating (on) the self: transforming agency through obesity surgery and treatment

In this article, I describe the processes through which patients diagnosed with ‘morbid obesity’ become active subjects through undergoing obesity surgery and an empowerment lifestyle programme in a Dutch obesity clinic. Following work in actor‐network theory and material semiotics that complicates the distinction between active and passive subjects, I trace how agency is configured and re‐distributed throughout the treatment trajectory. In the clinic's elaborate care assemblage – consisting of dieticians, exercise coaches and psychologists – the person is not only actively involved in his/her own change, the subject of intervention is the self as ‘actor’: his/her material constitution, inclinations and feelings. The empirical examples reveal that a self becomes capable of self‐care only after a costly and laborious conditioning through which patients are completely transformed. In this work, the changed body, implying a new, potentially disruptive reality that patients must learn to cope with, is pivotal to what the patient can do and become. Rather than striving to be disembodied, self‐contained liberal subjects that make sensible decisions for their body, patients become empowered through submission and attachment and by arranging support.     

Initiating decision‐making in neurology consultations: ‘recommending’ versus ‘option‐listing’ and the implications for medical authority

This article compares two practices for initiating treatment decision‐making, evident in audio‐recorded consultations between a neurologist and 13 patients in two hospital clinics in the UK. We call these ‘recommending’ and ‘option‐listing’. The former entails making a proposal to do something; the latter entails the construction of a list of options. Using conversation analysis (CA), we illustrate each, showing that the distinction between these two practices matters to participants. Our analysis centres on two distinctions between the practices: epistemic differences and differences in the slots each creates for the patient’s response. Considering the implications of our findings for understanding medical authority, we argue that option‐listing – relative to recommending – is a practice whereby clinicians work to relinquish a little of their authority. This article contributes, then, to a growing body of CA work that offers a more nuanced, tempered account of medical authority than is typically portrayed in the sociological literature. We argue that future CA studies should map out the range of ways – in addition to recommending – in which treatment decision‐making is initiated by clinicians. This will allow for further evidence‐based contributions to debates on the related concepts of patient participation, choice, shared decision‐making and medical authority.     

Home as a hybrid centre of medication practice

This article presents research that explores how medications are understood and used by people in everyday life. An intensive process of data collection from 55 households was used in this research, which included photo‐elicitation and diary‐elicitation interviews. It is argued that households are at the very centre of complex networks of therapeutic advice and practice and can usefully be seen as hybrid centres of medication practice, where a plethora of available medications is assimilated and different forms of knowledge and expertise are made sense of. Dominant therapeutic frameworks are tactically manipulated in households in order for medication practices to align with the understandings, resources and practicalities of households. Understanding the home as a centre of medication practice decentralises the role of health advisors (whether mainstream or alternative) in wellness practices.     

Constructing queer mother‐knowledge and negotiating medical authority in online lesbian pregnancy journals

Medical interactions around reproduction are increasingly extending beyond the physician's office and onto the Internet, where negotiation with medical authority occurs in complex and dynamic ways. Recently, scholars have noted the Internet's potential for creating spaces where women can dialogue with and reconstruct medical authority, yet this growing body of work is overwhelming heteronormative. This paper thus interrogates how lesbian women use the Internet to challenge, deploy, and rework medical authority around reproduction while navigating the transition to parenthood. I draw from 17 online journals authored by lesbian couples during the conception, pregnancy, and birth of their first child, each spanning between 18 months and 2 years, in order to understand how the transition process unfolds over time. I argue that lesbian couples engage with medical authority when seeking affirmation and normalisation yet discard and publicly reject the heteronormative assumptions that accompany reproductive medicine. Further, they chart a new process that I term ‘constructing queer mother‐knowledge’, in which they critique and balance knowledges from institutionalised medicine, their own bodies, and their queer communities. With this new concept, I complicate understandings of lesbian mothers‐to‐be and their interactions with medical authority as they build subversive families.     

The body and doing gender: the relations between doctors and nurses in hospital work

Abstract This article attempts to show how the concept of the body – as it has been applied in feminist thought – can be utilised in trying to understand the changing and at times problematic working relations between doctors and nurses in Sweden. Three approaches are applied with respect to the body: (1) Doctors and nurses belong to two different collective bodies which embody historical constructions of masculinity and femininity – which in turn have influenced how members of each corps have seen and worked with the other and how they approach each other even in the present day. (2) Gender is inscribed on the body. It is contended that in social encounters we never interact with each other as genderless beings, although we may very well take gender for granted and its importance may possibly be most salient in initial encounters. A nurse, then, never just interacts with a doctor – it is a female doctor or a male doctor and this makes a difference. ‘Doing gender’ is accomplished in these practices. (3) There is the question of situatedness– where (hospital staff) bodies find themselves on the ward and in the hospital in the daily run of things. Space and place are not neutral but are linked to relations of power and gender and class. How doing dominance and doing deference are accomplished – but also changed – in hospital work is addressed.     

A 'quiet' crisis in health care: developing our capacity to hear

Abstract In this paper we suggest that it is a mistake to understand the current situation in nursing as primarily a problem of 'shortage', a problem which may be solved through supplying 'more nurses, faster'. This way of thinking is understood as reflecting an invalidation of nurses and nursing and, by fostering false beliefs about nursing, as functioning to exacerbate rather than resolve the current situation. Unlike many mainstream conceptualizations of the current situation in nursing, we begin by understanding the experiences and concerns of nurses as meaningful. Feminist and hermeneutic philosophies, as well as Foucauldian perspectives on discourse, encourage us to take seriously the gender relations of power through which nursing comes to be articulated and to cultivate ways of thinking which can generate more productive analyses of the current situation in nursing. Rather than accepting instrumental understandings of nursing as adequate, we question the everyday beliefs and assumptions, the dominant discourses at work both in the world and in ourselves, which allow the suffering of nurses to be thought irrelevant and their concerns to remain unheard. We theorize both why the suffering of nurses can be considered irrelevant in this way and the difference it would make were we to take the experiences of nurses seriously. This undertaking requires that we reflect on that which constrains – and enables – the ways we are able to write, speak and think about nursing.     

The co-marking of aged bodies and migrant bodies: migrant workers' contribution to geriatric medicine in the UK

This article sits at the nexus between two bodies of work, gerontology and migration research, both of which have theorised the body as the locus of stigma. Gerontologists, while acknowledging the significance of perceptions of the ageing body for engagement and participation in society, have often evaded direct engagement with physical and medical understandings of older bodies. In parallel, research which focuses on migration, race and the body has focused on how the migrant body is stigmatised both because of its somatic markers and because of the status of the frail older people whom they tend. Drawing on oral history interviews with UK born and South Asian overseas-trained geriatricians, the article argues that the two bodies, which are usually seen in negative ways, came together in meaningful ways in the development of the specialty of geriatric medicine. Thinking of the body as an assemblage with many elements, some of which are stigmatised but which can nevertheless be recuperated, helps us to think beyond stigma in the context of body work.     

Biographical value: towards a conceptualisation of the commodification of illness narratives in contemporary healthcare

Illness narratives play a central role in social studies of health and illness, serving as both a key theoretical focus and a popular research method. Despite this, relatively little work has gone into conceptualising how and why illness narratives – be they in books, websites, television or other media – are commodified in contemporary healthcare and its social environment; namely, how distinctive forms of value are generated in the production, circulation, use and exchange of illness narratives. In this article we propose the notion of biographical value as a first step towards conceptualising the values attributed to illness narratives in this context. Based on a secondary analysis of 37 interviews with people affected by 15 different health conditions in the UK (all of whom have shared their illness experiences across various media) and drawing on understandings of value in research on the bioeconomy and the concept of biovalue in particular, we sketch out how epistemic, ethical and economic forms of value converge and co‐constitute each other in the notion of biographical value and in broader economies of illness experiences.     

Liminal space and the negotiation of care work in extra-care housing

This is a qualitative case study of care work in a liminal space, specifically the case of an extra-care housing residence, which is an innovative housing alternative for elderly people in need of care in Sweden. The study is an exploration of social care workers' perceptions about their workplaces and their understandings of themselves, which are shaped by their embeddedness in architectural space. The extra-care housing residence appeared as a liminal space in which two dominant spaces – home care services and residential care – underpinned the staff's perceptions of an unclear workplace and their identity work.     

The art and nature of health: a study of therapeutic practice in museums

Drawing on ethnographic fieldwork and interviews at a major metropolitan art museum and botanic garden, this article considers the practical accomplishment of American museums’ ‘health turn’ by tracing how museum staff develop therapeutic programmes for visitors with disabilities. In doing so, it considers one of medical sociology's fundamental theoretical questions – how ideologies of health order social life – in an unconventional empirical setting. Acknowledging contemporary arguments for both the relative merits and unintended consequences of this policy trend, I focus instead on the particular institutional arrangements, professional norms, and material cultures of art and nature that shape museums’ therapeutic work, so as to reveal its effects. Data reveals ideological similarities, but practical differences, between museological and medical understandings of wellness. Extending a ‘medical sociology of practice’ to new contexts ultimately foregrounds the contingencies, and diversity, of therapeutic mechanisms and meanings, thereby broadening sociological research on healing and healthism.