Sociology of health & illness最新文献

The predictive genetic clinic is a space where counsellors use non-directive counselling to facilitate asymptomatic patients at risk of carrying a dominantly inherited disease access a predictive genetic test. The social science literature has a history of examining practices within this clinic, but with little attention from the sociology of identity. In this paper, we highlight the importance of identity within these clinics by examining how currently healthy patients anticipate the prospect of a future identity of illness and death. We do this by examining how patients authenticate a decision to take a predictive genetic test for Huntington's Disease (HD). In deciding to take this test, a patient simultaneously asserts that they want the test, and they will be able to cope with a positive (bad news) test result. Positioning this as a claim to authenticity using Habermas, we explore authentic decision making through four themes-vouching, calibrating, reassuring and projecting. Non-directive counselling provides space for patients to articulate the authenticity of their decision while enabling counsellors probe their decision. However, counselling risks hindering authentic decision making and may devalue the social and familial as bases for efforts to authenticate.

Prompted by intense public debate and policy shifts, this study examines news media representations of gender-affirming care for transgender and gender diverse (TGD) youth in Sweden from 2019 to 2023. The analysis draws on Hall's theories of media representation and articulation, with a framework focussing on risk and temporality. Analysing media representations is crucial for understanding how societal discourses on gender dysphoria are shaped. The media articulates a dramatic rise in youth seeking gender-affirming care, and portrays a new group of patients, primarily young "girls" with neuropsychiatric conditions. This group is frequently articulated as vulnerable, mentally unstable and influenced by social contagion. The media representations draw on a risk discourse, centred on the threat of future regret, the irreversibility of medical interventions and suicidality. Both critics and supporters of gender-affirming care invoke suicide risk to justify their positions. The study highlights how TGD youths' voices are largely absent from the media representations. It critiques the simplified constructions of gender dysphoria and calls for more nuanced understandings of the rise of a diagnosis, care access and mental health. Finally, the paper illustrates shifting alliances and resistance within a broader conjuncture where professional and cultural tensions shape public discourse on gender-affirming care.

DCIS, or ductal carcinoma in situ-also known as Stage 0 breast cancer-accounts for approximately 20 per cent of new breast cancer cases. Although it is noninvasive, treatment typically mirrors that of invasive cancer. Whether DCIS is overtreated remains controversial, even among medical professionals. This study analyses discussions within a Facebook group of women diagnosed with DCIS who have declined the standard of care (SOC). The findings suggest that these women hold contrasting views on cancer risk compared to their healthcare providers. Although doctors focus on the potential for DCIS to progress to invasive cancer, the women emphasise the higher likelihood of nonprogression. Their considerations of alternative treatments are often dismissed by medical professionals, heightening the stress of an already anxiety-inducing diagnosis. This online community provides affirmation and support to those who choose holistic approaches to manage their condition. However, rejecting the SOC shifts the responsibility for healing onto the individual. These women must engage in vigilant self-surveillance, maintain strict healthy lifestyles and uphold an optimistic outlook-demands that require significant physical discipline and emotion work. This case carries important implications for both sociological research and medical practice.

Algorithmic technologies such as machine learning, generative artificial intelligence (GenAI) and automated decision-making have become one of the frontiers of contemporary technoscientific innovation in healthcare. However, algorithmic technologies can never be seen in isolation from the networks in which they are embedded. Not only are they woven into situated sociotechnical assemblages of human and nonhuman entities-tools, objects and other technologies-but their entanglements also reach into regulatory institutions and markets. This paper conceptualises GenAI in healthcare 'in the making' at the rapidly changing intersection of three spheres: regulatory, market and healthcare delivery. Our study, conducted in conjunction with two nongovernmental social justice organisations, explores how this intersection is currently 'motored' by data justice concerns on the one hand and data capitalist objectives on the other. We draw health sociologists' attention to the technopolitics and market interests that lie behind AI promissories and implementations in healthcare. More importantly, we contribute to collective thinking around how we may steer this dynamic towards the empowerment of civic society, dynamic regulation and a push for public value-rather than enrichment of the few.

This article examines how commercial artificial intelligence (AI) systems are integrated into the visual practice of colonoscopy and how they reshape the clinical gaze as a sociotechnical and situated mode of perception. Based on ethnographic observations of colonoscopies and in-depth interviews with gastroenterologists, this study analyses the real-time use of AI-based pattern recognition systems during diagnostic procedures. Unlike retrospective image analysis in radiology, AI in colonoscopy operates in vivo and in real time, requiring practitioners to engage with algorithmic markings within the unfolding process of examination. The clinical gaze emerges here as a form of professional vision constituted through embodied routines, tacit knowledge, technological infrastructures and institutionalised practices. This article identifies three modes of integrating AI-technology-driven, experience-driven and interrupted-that reveal the contingency and multiplicity of human-machine relations in clinical imaging work. Rather than displacing the clinical gaze, AI alters the conditions under which it can be enacted, bringing with it shifting forms of visual selectivity, epistemic authority and new uncertainties. This study contributes to sociological debates on algorithmic medicine and digital automation by showing how AI systems intervene in the practical organisation of medical seeing, highlighting the tensions and adjustments through which contemporary visual practices in healthcare are reconfigured.

This study examines how chronic pain advocates in Canada navigated fraught relationships with pharmaceutical companies amid escalating concerns about the adverse public health impacts of opioids. Drawing on 22 qualitative interviews with professional chronic pain advocates, it examines how advocates navigated their complex relationships with pharmaceutical companies amid structural constraints and limited institutional support. Findings reveal that advocates viewed pharmaceutical funding not primarily as an ethical compromise, but as a pragmatic necessity driven by pervasive stigma, institutional neglect and inadequate public funding. Credibility that advocacy groups once gained through association with opioid manufacturers became a reputational liability as industry involvement in widespread harms came into focus and the field shifted toward pharmacovigilance and accountability. In this way, chronic pain advocacy has become entangled in a process that both legitimises the condition and embeds the institutionalisation of pharmaceutical treatment as its dominant response. By situating advocates' decisions within broader organisational arrangements, this study contributes to sociological understandings of pharmaceuticalisation and disease-based advocacy as processes shaped by strategic action under constraint.

This commentary considers how Robert Crawford's concept of healthism may be applied to the current conditions of misinformation, populist and libertarian politics and declining interest by governments, health authorities and citizens in controlling the COVID-19 crisis. In this latest pandemic phase, antiscience and antivaccination sentiment and distrust in 'big government' and public health measures have intensified across the globe. These changes have led to government by hollow states and the erosion of the social solidarity that is essential to successful public health interventions. Two new modes of healthism are identified and described as arising from these biopolitical conditions: reverse healthism and antiscience healthism.

People living with endometriosis, a disease in which tissue similar to the lining of the uterus grows elsewhere in the body, often experience prolonged diagnostic journeys because of symptom variability, normalisation of period pain and other symptoms, and lack of awareness of the condition. In this article, we analyse the endometriosis diagnostic journey through the lens of epistemic injustice. Drawing on in-depth interviews with 52 people living with endometriosis in the United States, we introduce the concept of diagnostic buck-passing to characterise the phenomenon wherein individuals who seek treatment for their symptoms end up stuck in a cycle of seeing different providers across ranging specialities, which ultimately delays their diagnosis. We describe diagnostic buck-passing and the conditions that give rise to its emergence, grounding our conceptualisation in endometriosis diagnosis. Utilising concepts of undone science and wilful ignorance, we demonstrate how endometriosis diagnosis becomes a site of hermeneutical injustice due to a long history of underinvestment in women's health research and resultant knowledge gaps in clinical care.

This article examines how differences in forms of capital shape families' experience of navigating complex health and welfare institutions within a system formally committed to equality and universal provision. Using Bourdieu's theory of capital, this study explores how parents of disabled children in Norway mobilise various resources to access, coordinate and manage health and welfare services. Based on qualitative interviews with 21 families, the analysis shows how these forms of capital function as both enabling and constraining mechanisms. Cultural capital supports alignment with bureaucratic expectations. Social capital provides access to practical support and insider knowledge. Economic capital offers flexibility and helps fill gaps where services fall short. Crucially, the ability to activate these resources depends on families' mental and physical stamina. This article shows how the navigation of health and welfare services is shaped by the interaction between institutional structures and families' capacity to mobilise resources, producing socially patterned differences in how the process unfolds.

The proportion of midlife Australian women (45-64 years) whose alcohol consumption is defined as 'long-term risky drinking' increased between 2001 and 2019, with serious health, economic and social impacts. Although overall population consumption trends towards a decline, consumption for this population remains stable, suggesting that current alcohol reduction policies and strategies are ineffective for this population. In this paper, we employ sociological theory on hope to argue for developing alcohol policies that are structured to enable women's hopes for a future that includes alcohol reduction. Drawing on humanistic and positive sociology that is concerned with future-focused enquiries, we undertook semi-structured interviews with 26 midlife women, exploring 'if' they could reduce their drinking, then what hopes might be enabled through alcohol reduction. Women talked about imagined alcohol-reduced futures as enabling hopes for control, responsibility, stability and health in their lives, to support them to care for others and be 'normal'. Quixotic hopes around excitement, freedom and having a 'good life' were expressed to a lesser extent than expected. Our study and findings are analysed in relation to sociological and (post-structural) feminist theories of oppression and political transformation, with implications for alcohol policy scaffolded by engagement with Freire's pedagogy of hope.