Contesting contraceptive innovation—Reinventing the script

Reprint of: Biotechnologies and the future of opioid addiction treatments

The future of treatment-including addiction treatment-is biotechnological. Depot injections, agonist/antagonist implants, deep brain stimulation, and hapten conjugate vaccines are hailed by researchers and pharmaceutical manufacturers as medicine's best hope to minimize illicit use, to decrease risk of overdose and painful withdrawal, and to prevent diversion of medicines to illicit markets. Marketing and use of new technologies reveal old tensions framing concepts of addiction and its treatment: between medical condition and disorder of the will, between criminal justice and health, and between patient choice and system control. Using the examples of depot naltrexone and implantable and injectable buprenorphine in the U.S., this essay considers the arc of long-acting opioid treatment and implications for the future. These include the rise of Vivitrol courts and "carceral prescription"-where criminal justice systems mandate medicine to lock up brain receptors much as they might lock up people themselves-as well as use of buprenorphine formulations positioned as increasing both patient benefit and provider control. We also consider lessons from debates on long-acting contraceptive technologies such as Norplant and Depo-Provera. While multiple new long-acting formulations are under development, success will be determined less by characteristics of particular formulations and more by whether or not the new technologies are accompanied by a new ethics of addiction treatment that emphasizes therapeutic alliance, concordance over compliance, and a genuine commitment to allowing patients the ability to narrate and be believed in their descriptions of their treatment experiences.

Biotechnologies and the future of opioid addiction treatments

The future of treatment-including addiction treatment-is biotechnological. Depot injections, agonist/antagonist implants, deep brain stimulation, and hapten conjugate vaccines are hailed by researchers and pharmaceutical manufacturers as medicine's best hope to minimize illicit use, to decrease risk of overdose and painful withdrawal, and to prevent diversion of medicines to illicit markets. Marketing and use of new technologies reveal old tensions framing concepts of addiction and its treatment: between medical condition and disorder of the will, between criminal justice and health, and between patient choice and system control. Using the examples of depot naltrexone and implantable and injectable buprenorphine in the U.S., this essay considers the arc of long-acting opioid treatment and implications for the future. These include the rise of Vivitrol courts and "carceral prescription"-where criminal justice systems mandate medicine to lock up brain receptors much as they might lock up people themselves-as well as use of buprenorphine formulations positioned as increasing both patient benefit and provider control. We also consider lessons from debates on long-acting contraceptive technologies such as Norplant and Depo-Provera. While multiple new long-acting formulations are under development, success will be determined less by characteristics of particular formulations and more by whether or not the new technologies are accompanied by a new ethics of addiction treatment that emphasizes therapeutic alliance, concordance over compliance, and a genuine commitment to allowing patients the ability to narrate and be believed in their descriptions of their treatment experiences.

Fluid Drugs: Revisiting the Anthropology of Pharmaceuticals

This review discusses a growing body of scholarship at the intersection of anthropology and science and technology studies (STS) that examines how drugs are rendered efficacious in laboratories, therapeutic settings, and everyday lives. This literature foregrounds insights into how commercial interests and societal concerns shape the kinds of pharmaceutical effects that are actualized and how some efficacies are blocked in response to moral concerns. The work brought together here reveals how regulatory institutions and health policy makers seek to stabilize pharmaceutical actions while, on the front lines of care, pharmacists, health workers, and users tinker with dosages and indications to tailor pharmaceutical actions to specific circumstances. We show that there is no pure (pharmaceutical) object that precedes its socialization. Pharmaceuticals are not “discovered”; they are made and remade in relation to shifting contexts. This review outlines five key areas of ethnographic and STS research that examines such fluid drugs.

Magic Power: changing gender dynamics and sex-enhancement practices among youths in Makassar, Indonesia

This paper examines changing sexualities and gender relations as they are reflected in the use of sexual enhancement products by young women and men in the eastern Indonesian city of Makassar. To examine the relationships between the use of these products and socially sanctioned gender roles, their 'gender scripts' were studied--the assumptions embedded in the products' design and advertising. What kinds of femininity and masculinity are expressed through their use? It was found that the most popular products--'magic tissues' that promise to prolong erections and a 'neotraditional' vaginal wash that promises to cleanse, perfume, and tighten vaginas--espouse the dual purpose of promoting sexual pleasure and hygiene. While it was found that the images in advertising to reflect changing gender relations in the field site, this research also points to enduring gender scripts in Indonesian culture: men should be virile, women should be clean and attractive.

Introduction: Patient organization movements and new metamorphoses in patienthood

In this introduction, we examine health activism as one expression of an emergent 'politics of vitality' or flurry of activity around health matters that includes: advances in technoscientific medicine, healthcare restructurings, and a re-thinking of science-society contracts. In querying politicized mobilizations around 'health matters and the mattering of health,' we provocatively entitle our discussion 'patient organization movements'. This marks an invitation to interrogate (in reverse order) each term along the way, pausing in our concluding discussion to turn our attentions to the patient. The figure of the patient is thematized as an historical inscription and a formidable dimension of personhood under modernity/late modernity. Moreover, we argue that conventional categorizations of the patient are undergoing accelerated processes of change at the present time. We characterize three transformational trends: moves to author and authorize patienthood, mutiny from patienthood, and mutations in the category of the patient. Such metamorphoses in patienthood represent both reflections and repercussions--at once consequences and catalysts--of the proposed politics of vitality. We explore the pluralization of the patient's persona via a closer look at the 11 empirical studies of health activism that comprise this collection.