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Huang K, Krafft PM. Performing Platform Governance: Facebook and the Stage Management of Data Relations. Sci Eng Ethics 2024; 30:13. [PMID: 38575812 PMCID: PMC10995037 DOI: 10.1007/s11948-024-00473-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 02/12/2024] [Indexed: 04/06/2024]
Abstract
Controversies surrounding social media platforms have provided opportunities for institutional reflexivity amongst users and regulators on how to understand and govern platforms. Amidst contestation, platform companies have continued to enact projects that draw upon existing modes of privatized governance. We investigate how social media companies have attempted to achieve closure by continuing to set the terms around platform governance. We investigate two projects implemented by Facebook (Meta)-authenticity regulation and privacy controls-in response to the Russian Interference and Cambridge Analytica controversies surrounding the 2016 U.S. Presidential Election. Drawing on Goffman's metaphor of stage management, we analyze the techniques deployed by Facebook to reinforce a division between what is visible and invisible to the user experience. These platform governance projects propose to act upon front-stage data relations: information that users can see from other users-whether that is content that users can see from "bad actors", or information that other users can see about oneself. At the same time, these projects relegate back-stage data relations-information flows between users constituted by recommendation and targeted advertising systems-to invisibility and inaction. As such, Facebook renders the user experience actionable for governance, while foreclosing governance of back-stage data relations central to the economic value of the platform. As social media companies continue to perform platform governance projects following controversies, our paper invites reflection on the politics of these projects. By destabilizing the boundaries drawn by platform companies, we open space for continuous reflexivity on how platforms should be understood and governed.
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Affiliation(s)
- Karen Huang
- McCourt School of Public Policy, Georgetown University, Washington, DC, USA.
| | - P M Krafft
- Creative Computing Institute, University of the Arts London, London, UK
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2
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Lewis S, Willis K, Smith L, Dubbin L, Rogers A, Moensted ML, Smallwood N. There but not really involved: The meanings of loneliness for people with chronic illness. Soc Sci Med 2024; 343:116596. [PMID: 38246108 DOI: 10.1016/j.socscimed.2024.116596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/01/2024] [Accepted: 01/10/2024] [Indexed: 01/23/2024]
Abstract
Loneliness is one of the most pressing and rapidly growing contemporary social challenges around the world. Yet we still lack a good understanding of how loneliness is constituted and experienced by those most affected. We conducted semi-structured interviews with 40 people with chronic illness who were experiencing loneliness to explore what loneliness means to them and how it impacts in their daily lives. Drawing on ideas around liquidity and performativity, we identified the relational, temporal and social layers of loneliness. Our analysis revealed the interconnectedness of chronic illness and loneliness in participants' daily lives, as well as how chronic illness shifts temporal orientation, and transforms interpersonal relationships and relationship with self, contributing to the experiences of loneliness. Though participants described the many social conditions that restricted their opportunities for social participation, giving them a sense of being left behind and spectating the social life of others, a rhetoric of loneliness as a problem and responsibility of the individual was still prominent. A narrative of the need to perform social connection emerged in the absence of meaningful social bonds with others. We argue that normative ideals of wellness and positivity circulating in chronic illness communities and society more broadly are implicated in the experience of loneliness for people with chronic conditions. We conclude by considering how more expansive representations of how to live well with chronic illness may be important in reducing personal and collective loneliness.
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Affiliation(s)
- Sophie Lewis
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.
| | - Karen Willis
- Public Health, Institute for Health & Sport, Victoria University, Victoria, Australia
| | - Lorraine Smith
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | | | - Anne Rogers
- University of Southampton, Southampton, United Kingdom
| | - Maja Lindegaard Moensted
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Natasha Smallwood
- Central Clinical School, The Alfred, Monash University, Victoria, Australia
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3
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Petzke M. The Assemblage and Dismantling of Access Barriers in Administrative Bureaucracies: Constructing the Problem of Diversity in the German Welfare State. Qual Sociol 2024; 47:69-94. [PMID: 38500842 PMCID: PMC10944437 DOI: 10.1007/s11133-023-09555-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 03/20/2024]
Abstract
The article extends the literature on the construction of "diversity management" by personnel managers in corporate America. Such research has highlighted that Human Resource (HR) specialists draw heavily on social-scientific thinking in implementing various remedies against discrimination. However, it has paid less attention to how such esoteric views of reality, comprising such "things" as "structural barriers" impeding occupational advancement and "diversity sensitivity," have been successfully established as a self-evident reality in the workplace. In order to more thoroughly investigate how the world of diversity management is established outside the circle of academic specialists, the article employs perspectives from science and technology studies on the ways in which sociotechnical assemblages, i.e., networks of human actors and material devices, enact scientific ontologies. It applies such perspectives to a German case of diversity management, a program of "intercultural opening" that seeks to make bureaucracies of the welfare state more accessible to immigrants. The article delineates the specific ontology behind this version of diversity management, rooted in sociological perspectives on social mobility, and explores the various techniques and instruments through which officers of intercultural opening establish this ontology as a visible reality in municipal administrations.
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Affiliation(s)
- Martin Petzke
- Bielefeld University, Universitätsstr. 25, 33615 Bielefeld, Germany
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Vergara-Fernández M, Heilmann C, Szymanowska M. Contextualist model evaluation: models in financial economics and index funds. Eur J Philos Sci 2023; 13:6. [PMID: 36714209 PMCID: PMC9860242 DOI: 10.1007/s13194-022-00506-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/20/2022] [Indexed: 06/18/2023]
Abstract
Philosophers of science typically focus on the epistemic performance of scientific models when evaluating them. Analysing the effects that models may have on the world has typically been the purview of sociologists of science. We argue that the reactive (or "performative") effects of models should also figure in model evaluations by philosophers of science. We provide a detailed analysis of how models in financial economics created the impetus for the growing importance of the phenomenon of "passive investing" in financial markets. Considering this case motivates the position that we call contextualism about model evaluation, or model contextualism for short. Model contextualism encompasses standard analyses of the epistemic performance of the model, but also includes their reactive aspects. It entails identifying the epistemic and contextual import of the model, the ways in which a model can engender change in the world (which we call the channels of transmission), and the interactions between the epistemic and reactive import of a model.
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Affiliation(s)
- Melissa Vergara-Fernández
- Erasmus Institute for Philosophy and Economics (EIPE), Erasmus School of Philosophy, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Conrad Heilmann
- Erasmus Institute for Philosophy and Economics (EIPE), Erasmus School of Philosophy, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Marta Szymanowska
- Department of Finance, Rotterdam School of Management, Erasmus University Rotterdam, Rotterdam, Netherlands
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van der Linden R, Bolt T, Veen M. 'If it can't be coded, it doesn't exist'. A historical-philosophical analysis of the new ICD-11 classification of chronic pain. Stud Hist Philos Sci 2022; 94:121-132. [PMID: 35749830 DOI: 10.1016/j.shpsa.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 04/10/2022] [Accepted: 06/06/2022] [Indexed: 06/15/2023]
Abstract
Chronic pain entails a large burden of disease and high social costs, but is seldom 'in the picture' and barely understood. Until recently, it was not systematically classified but instead viewed as a symptom or sign. In the new International Classification of Diseases, (ICD)-11, to be implemented in 2022, 'chronic' pain is now classified as a separate disease category and, to a certain extent, approached as a 'disease in its own right'. Reasons that have been given for this are not based so much on new scientific insights, but are rather of pragmatic nature. To explore the background of these recent changes in definition and classification of chronic pain, this paper provides a historical-philosophical analysis. By sketching a brief history of how pain experts have been working on the definition and taxonomy since the 1970s, we demonstrate the various social and practical functions that underlie the new ICD-11 classification of chronic pain. Building on this historical-empirical basis, we discuss philosophical issues regarding defining and classifying chronic pain, in particular performativity and pragmatism, and discuss their implications for the broader philosophical debate on health and disease.
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Affiliation(s)
- Rik van der Linden
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands.
| | - Timo Bolt
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands.
| | - Mario Veen
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands.
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Peel JK, Flexman AM, Cygler J, Kirkham KR, Lorello GR. Standing out or fitting in: A latent projective content analysis of discrimination of women and 2SLGBTQ+ anesthesiologists and providers. J Clin Anesth 2022; 80:110884. [PMID: 35597003 DOI: 10.1016/j.jclinane.2022.110884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/08/2022] [Accepted: 05/11/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Discrimination toward sex and gender minority anesthesiologists and anesthesia trainees exists. Potential reasons for this discrimination are unclear and incompletely characterized. This study sought to better understand what discrimination looks like for sex and gender minorities in anesthesiology and the culture within anesthesiology that allows this discrimination to occur. MATERIALS AND METHODS With institutional research ethics board approval and informed consent, we performed a qualitative analysis of free-text responses from a previously-published internet-based cross-sectional survey distributed to Canadian anesthesiology residents, fellows, and staff. The purpose of this survey was to characterize intersections between respondent gender or sexuality with experiences of discrimination in the workplace. Separate analysis of qualitative and quantitative components of this survey was planned a priori, and the quantitative component was published elsewhere. Free-text responses were independently coded by two researchers and subsequently synthesized into emerging themes using latent projective content analysis sensitized by Butler's theory of performativity. RESULTS Out of 490 free-text responses from 171 respondents [140 (81.9%) identifying as heterosexual], two themes emerged: i) fitting in: performativity reinforcing the status quo, and ii) standing out: performativity as a means of disruptive social change. Power structures were observed to favour individuals who "fit in" with the normative performances of gender and/or sexuality. DISCUSSION Our study illuminates how individuals whose performances of gender and sexuality "fit in" with those expected normative performances reinforce a workplace culture that advantages them, whereas individuals whose performances of gender and sexuality "stand out" disproportionately experience discrimination. The dismantling of bias and discrimination in the anesthesiology workplace requires individuals (a) who are empowered within their workplace because they "fit in" with the majority; (b) who recognize discrimination toward communities of their peers and/or colleagues; and (c) who actively choose to "stand out".
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Affiliation(s)
- John K Peel
- University of Toronto, Department of Anesthesiology and Pain Medicine, Toronto, ON, Canada
| | - Alana M Flexman
- The University of British Columbia, Department of Anesthesiology, Pharmacology and Therapeutics, Vancouver, BC, Canada
| | - Jeremy Cygler
- University of Toronto, Department of Medicine, Toronto, ON, Canada
| | - Kyle R Kirkham
- University of Toronto, Department of Anesthesiology and Pain Medicine, Toronto, ON, Canada; University Health Network - Toronto Western Hospital, Department of Anesthesia and Pain Management, Toronto, ON, Canada
| | - Gianni R Lorello
- University of Toronto, Department of Anesthesiology and Pain Medicine, Toronto, ON, Canada; University Health Network - Toronto Western Hospital, Department of Anesthesia and Pain Management, Toronto, ON, Canada; The Wilson Centre, University Health Network, Toronto, ON, Canada; Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
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Abstract
This paper illustrates the performative nature of participatory video (PV), drawing on JL Austin's well-known work on speech acts, utterances, and performative sentences, as well as Butler's reworking and application of the notion of performativity. During recent research I used PV as a method. Sub-Saharan African refugee research participants who had not known each other before the PV project negotiated issues to be filmed and made a short film together, creating a small community where none existed before, who are taking steps to organize collective action. The emergence of this new community in and through the making of the film during the fieldwork illustrates the performativity of PV, what is accomplished in and through its making. This performativity works not only through people who take part in creating a video, distributing the video, and watching the video, but also may have effects on people who have never seen the given video, as they are in a landscape and embedded in social relations affected by people who took part in it or saw it. PV is thus both a way of gathering data to learn about the world, and it also is involved in changing it, bringing forth new relationships and new ways of being.
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Affiliation(s)
- Özlem Ayse Özgür
- School of Geography, Development and Environment, University of Arizona, Tucson, USA
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8
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Yang S, Shu D, Yin H. "Teaching, my passion; publishing, my pain": unpacking academics' professional identity tensions through the lens of emotional resilience. High Educ (Dordr) 2022; 84:235-254. [PMID: 34565827 PMCID: PMC8456393 DOI: 10.1007/s10734-021-00765-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/06/2021] [Indexed: 05/22/2023]
Abstract
In the global competition of higher education, an increasing emphasis has been placed on university research excellence. Accordingly, academics have to engage in both research and teaching activities. The multiple and fragmented identities of academics can sometimes be contested, leading to identity tensions, and impeding their professional development. This raises the issue of how, and whether at all, academics integrate their professional identities in a culture of performativity. Against this backdrop, this qualitative study explored how a specific group of Chinese academics negotiate identity tensions as teachers and researchers through an emotional resilience lens. The narrative frames and interviews with 10 college English teachers yielded four types of identity negotiation in the continuum from identity conflicts to identity integration mediated by emotional resilience, including the disheartened performer, the miserable follower, the strenuous accommodator, and the fulfilled integrator. Emotional resilience as a mediator in professional identity tensions is discussed. Our findings offer a nuanced understanding of the complexity of academics developing an integrated professional identity. Policymakers should recognize the potential of emotional resilience in integrating academic professional identities and jointly support academics to cope with their identity tensions. However, if identity tensions are too complex for academics to solve, the policymakers should consider tensions as signals that the existing institutional policies may be counterproductive and need to be revised, rather than merely calling on academics' resilience.
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Affiliation(s)
- Shanshan Yang
- School of English Studies, Shanghai International Studies University, Shanghai, China
| | - Dingfang Shu
- School of English Studies, Shanghai International Studies University, Shanghai, China
| | - Hongbiao Yin
- Department of Curriculum and Instruction, Faculty of Education, Chinese University of Hong Kong, Hong Kong SAR, China
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9
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Gunnarson M, Kapeller A, Zeiler K. Ethico-Political Aspects of Conceptualizing Screening: The Case of Dementia. Health Care Anal 2021; 29:343-359. [PMID: 33725216 PMCID: PMC8560671 DOI: 10.1007/s10728-021-00431-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2021] [Indexed: 11/20/2022]
Abstract
While the value of early detection of dementia is largely agreed upon, population-based screening as a means of early detection is controversial. This controversial status means that such screening is not recommended in most national dementia plans. Some current practices, however, resemble screening but are labelled "case-finding" or "detection of cognitive impairment". Labelled as such, they may avoid the ethical scrutiny that population-based screening may be subject to. This article examines conceptualizations of screening and case-finding. It shows how the definitions and delimitations of the concepts (the what of screening) are drawn into the ethical, political, and practical dimensions that screening assessment criteria or principles are intended to clarify and control (the how of screening, how it is and how it should be performed). As a result, different conceptualizations of screening provide the opportunity to rethink what ethical assessments should take place: the conceptualizations have different ethico-political implications. The article argues that population-based systematic screening, population-based opportunistic screening, and case-finding should be clearly distinguished.
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Affiliation(s)
- Martin Gunnarson
- Department of Thematic Studies, Division of Technology and Social Change, Linköping University, Linköping, Sweden.
- Centre for Studies in Practical Knowledge, School of Culture and Learning, Södertörn University, Huddinge, Sweden.
| | - Alexandra Kapeller
- Department of Thematic Studies, Division of Technology and Social Change, Linköping University, Linköping, Sweden
| | - Kristin Zeiler
- Department of Thematic Studies, Division of Technology and Social Change, Linköping University, Linköping, Sweden
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10
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Zeiler K. An analytic framework for conceptualisations of disease: nine structuring questions and how some conceptualisations of Alzheimer's disease can lead to 'diseasisation'. Med Health Care Philos 2020; 23:677-693. [PMID: 32770447 PMCID: PMC7538407 DOI: 10.1007/s11019-020-09963-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
According to the US National Institute on Aging and the Alzheimer's Association (NIA-AA), Alzheimer's disease (AD) should be understood as a biological construct. It can be diagnosed based on AD-characteristic biomarkers only, even if AD biomarkers can be present many years before a person experiences any symptoms of AD. The NIA-AA's conceptualisation of AD radically challenges past AD conceptualisations. This article offers an analytic framework for the clarification and analysis of meanings and effects of conceptualisations of diseases such as that of AD. This framework consists of nine questions that allows us to determine how the conceptualisations of diseases, such as that of AD, link or decouple the following terms to/from each other: screening, diagnosis, pathology, disease (along the lines of what have been labelled as "biological-physiological" or "normative" conceptions of disease in philosophy of medicine), symptoms, and illness. It also includes questions regarding how specific decouplings open up for new categories through which people can understand themselves in new ways, and what spaces of possibilities specific conceptualisations (and their decouplings and linkages) open to. The article shows how specific decouplings/linkages can open up not only for the phenomena of pathologisation but also for a distinct, but related phenomenon here termed as diseasisation.
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Affiliation(s)
- Kristin Zeiler
- Department of Thematic Studies: Technology and Social Change, Linköping University, 581 83, Linköping, Sweden.
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Lancaster K, Rhodes T. Towards an ontological politics of drug policy: Intervening through policy, evidence and method. Int J Drug Policy 2020; 86:102932. [PMID: 32912826 DOI: 10.1016/j.drugpo.2020.102932] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 08/30/2020] [Accepted: 08/31/2020] [Indexed: 02/06/2023]
Abstract
Increasing attention has been paid to matters of ontology, and its accompanying politics, in the drug policy field. In this commentary, we consider what an 'ontological politics' might mean for how we think about what drug policy is and what it might become, as well as for how we think about (and do) research in drug policy. Thinking ontopolitically questions the tacitly accepted status of 'drug problems', calls into question the realist presumptions which underpin much drug policy analysis, and provokes thinking about what counts as 'evidence' and the 'evidence-based policy' paradigm itself. We call attention to the inventive possibilities of method when grappling with the challenges thrown forth by the ontological turn, with a renewed focus on practice and relations. An ontological politics disrupts consensual claims and draws critical attention to objects that might otherwise appear 'finished' or 'ready-made', not least the things we call 'drugs' and 'drug policy'. Working with 'drug policy multiples' invites new thinking and dialogue to provoke an ethico-political mode of intervention in the field of drug policy and drugs research.
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Affiliation(s)
| | - Tim Rhodes
- University of New South Wales, Sydney, Australia; London School of Hygiene and Tropical Medicine, UK
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12
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Buetow S. The Thin Man is His Clothing: Dressing Masculine to be Masculine. J Med Humanit 2020; 41:429-437. [PMID: 31989406 DOI: 10.1007/s10912-019-09605-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Body image research focuses almost exclusively on women or overweight and obesity or both. Yet, body image concerns among thin men are common and can result, at least in part, from mixed messages in society around how men qua men should dress and behave in order to look good and feel good. Stand-alone interventions to meet these different messages tend to provide men with little therapeutic relief. This conceptual paper draws on literature from the medical humanities; gender and body image studies; the social psychology of clothing; and the author's own lived experience to address this contemporary problem. The paper embraces visual culture as a resource that can frame discussion of how two sets of 'performativity' might reduce male anxiety about thinness. First, thin men could choose repeatedly to wear masculine-looking clothing, which could create their masculinity as a personal aesthetic that strengthens the confidence to harness masculine traits in healthy ways. Secondly, health and allied health service providers could promote and reinforce such dress behavior by offering advice that integrates aesthetic and functional aspects of clothing. Empirical studies are needed to test this dual model of performativity.
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Affiliation(s)
- Stephen Buetow
- Department of General Practice and Primary Health Care, University of Auckland, Private Bag 92019, Auckland, New Zealand.
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13
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May C, Myall M, Lund S, Campling N, Bogle S, Dace S, Richardson A. Managing patient preferences and clinical responses in acute pathophysiological deterioration: What do clinicians think treatment escalation plans do? Soc Sci Med 2020; 258:113143. [PMID: 32599414 PMCID: PMC7369631 DOI: 10.1016/j.socscimed.2020.113143] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/27/2020] [Accepted: 06/11/2020] [Indexed: 11/16/2022]
Abstract
Treatment Escalation Plans (TEPs) are paper and electronic components of patients' clinical record that are intended to encourage patients and caregivers to contribute in advance to decisions about treatment escalation and de-escalation at times of loss of capacity. There is now a voluminous literature on patient decision-making, but in this qualitative study of British clinicians preparing to implement a new TEP, we focus on the ways that they understood it as much more than a device to promote patient awareness of the potential for pathophysiological deterioration and to elicit their preferences about care. Working through the lens of Callon's notion of agencements, and elements of May and Finch's Normalisation Process Theory, we show how clinicians saw the TEP as an organising device that enabled translation work to elicit individual preferences and so mitigate risks associated with decision-making under stress; and transportation work to make possible procedures that would transport agreed patterns of collective action around organisations and across their boundaries and to mitigate risks that resulted from relational and informational fragmentation. The TEP promoted these shifts by making possible the restructuring of negotiated obligations between patients, caregivers, and professionals, and by restructuring practice governance through promoting rules and resources that would form expectations of professional behaviour and organisational activity. EoLC decision-making tools frame interaction processes in relational space. Decision-making tools transport patient preferences across organisational space. Agencement theory and Normalisation Process Theory work well together.
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Affiliation(s)
- Carl May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Michelle Myall
- NIHR CLAHRC Wessex, School of Health Sciences, University of Southampton, Building 67, Highfield Campus, University Road, Southampton, SO17 1BJ, UK.
| | - Susi Lund
- NIHR CLAHRC Wessex, School of Health Sciences, University of Southampton, Building 67, Highfield Campus, University Road, Southampton, SO17 1BJ, UK.
| | - Natasha Campling
- NIHR CLAHRC Wessex, School of Health Sciences, University of Southampton, Building 67, Highfield Campus, University Road, Southampton, SO17 1BJ, UK.
| | - Sarah Bogle
- NIHR CLAHRC Wessex, School of Health Sciences, University of Southampton, Building 67, Highfield Campus, University Road, Southampton, SO17 1BJ, UK.
| | - Sally Dace
- NIHR CLAHRC Wessex, School of Health Sciences, University of Southampton, Building 67, Highfield Campus, University Road, Southampton, SO17 1BJ, UK.
| | - Alison Richardson
- NIHR CLAHRC Wessex, School of Health Sciences, University of Southampton, Building 67, Highfield Campus, University Road, Southampton, SO17 1BJ, UK; University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Mailpoint 11, Clinical Academic Facility (Room AA102), South Academic Block, Tremona Road, Southampton, SO16 6YD, UK.
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14
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Rhodes T, Lancaster K. How to think with models and targets: Hepatitis C elimination as a numbering performance. Int J Drug Policy 2020; 88:102694. [PMID: 32245664 DOI: 10.1016/j.drugpo.2020.102694] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/28/2020] [Accepted: 01/29/2020] [Indexed: 12/13/2022]
Abstract
The field of public health is replete with mathematical models and numerical targets. In the case of disease eliminations, modelled projections and targets play a key role in evidencing elimination futures and in shaping actions in relation to these. Drawing on ideas within science and technology studies, we take hepatitis C elimination as a case for reflecting on how to think with mathematical models and numerical targets as 'performative actors' in evidence-making. We focus specifically on the emergence of 'treatment-as-prevention' as a means to trace the social and material effects that models and targets make, including beyond science. We also focus on how enumerations are made locally in their methods and events of production. We trace the work that models and targets do in relation to three analytical themes: governing; affecting; and enacting. This allows us to situate models and targets as technologies of governance in the constitution of health, which affect and are affected by their material relations, including in relation to matters-of-concern which extend beyond calculus. By emphasising models and targets as enactments, we draw attention to how these devices give life to new enumerated entities, which detach from their calculative origins and take flight in new ways. We make this analysis for two reasons: first, as a call to bring the social and enumeration sciences closer together to speculate on how we might think with models and targets differently and more carefully; and second, to encourage an approach to science which treats evidencing-making interventions, such as models and targets, as performative and political.
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Affiliation(s)
- Tim Rhodes
- London School of Hygiene and Tropical Medicine, London, United Kingdom; University of New South Wales, Sydney, Australia; National Institute of Health Research Health Protection Research Unit in Sexually Transmitted Infections and Blood Borne Viruses, University College London, United Kingdom.
| | - Kari Lancaster
- London School of Hygiene and Tropical Medicine, London, United Kingdom; University of New South Wales, Sydney, Australia
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Rhodes T, Lancaster K. Evidence-making hepatitis C cure: Towards a science that knows more carefully. Int J Drug Policy 2019; 72:40-6. [PMID: 31307851 DOI: 10.1016/j.drugpo.2019.06.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/27/2019] [Accepted: 06/28/2019] [Indexed: 11/22/2022]
Abstract
There has been some controversy concerning the curative potential of new treatments for hepatitis C. This follows a systematic review of the Cochrane Collaboration questioning the clinical benefits of direct-acting antivirals (DAAs). This controversy has been debated as a matter of methods regarding how best to evidence treatment in an evidence-based medicine (EBM) approach. Drawing from science and technology studies (STS), we offer an alternative perspective. We propose a different way of thinking with evidence; one which treats 'evidencing as performative'. Using the Cochrane review and its linked published responses as a resource for this analysis, we consider how hepatitis C cure is differently made-up through the knowledge-making practices performing it. We show how matters of apparent fact in evidence-based science are enacted as matters of clinical, social and ethico-political concern. We notice hepatitis C cure as a fluid object in negotiation. We highlight the limits of current debate to advocate a more critical and careful practice-based approach to knowing hepatitis C cure. This calls upon public health researchers to reflect on the performative work of their evidencing. We propose a 'more-than' EBM approach which treats 'evidence-based' science as an 'evidence-making intervention'. We consider the implications of such an approach for the evidencing of public health interventions and for treating hepatitis C in the DAA era of 'viral elimination'.
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Degli Esposti S, Pavone V. Oocyte provision as a (quasi) social market: Insights from Spain. Soc Sci Med 2019; 234:112381. [PMID: 31252241 DOI: 10.1016/j.socscimed.2019.112381] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 06/15/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
Abstract
The provision of oocytes plays an important role in human fertility treatments. Spain alone performs half of oocyte provision cycles in the European Union whilst all other European countries face an oocyte shortage. How do Spanish fertility clinics manage to match the increasing domestic and foreign demand for female oocytes? Adopting a weak performativity approach and drawing insights from interviews carried out with 20 fertility clinic representatives, this study suggests that Spanish clinics are successful thanks to an egg provision system designed as a (quasi) social market. In the absence of traditional market mechanisms based on price fluctuations, the combination of fixed monetary compensation for providers and altruistic framing of oocyte provision as an act of donation, are used to mobilize relatively high numbers of women. Fertility clinics optimize this supply through a set of supplementary strategies to ensure oocyte supply always meets oocyte demand. Though successful, this market design reinforces gender stereotypes and relies on manipulative notions of altruism. A clear but unacknowledged appropriation of women's bodies and reproductive labour are also operated, which reinforces and reproduces racial and social stratifications. Therefore, we ask whether alternative mechanisms to promote female solidarity across different generations, to raise awareness of the risks of advanced maternal age, and to explore alternative market designs should be considered.
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Affiliation(s)
- Sara Degli Esposti
- Instituto de Políticas y Bienes Públicos (IPP), Consejo Superior de Investigaciones Científicas (CSIC), C\ Albasanz 26-28, 28037 Madrid, Spain; Centre for Business in Society (CBiS), Coventry University, Jaguar Building, Coventry CV1 5DL, UK.
| | - Vincenzo Pavone
- Instituto de Políticas y Bienes Públicos (IPP), Consejo Superior de Investigaciones Científicas (CSIC), C\ Albasanz 26-28, 28037 Madrid, Spain.
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Abstract
Recent work in medical sociology has provided critical insights into distinguishing between obesity as a condition with severe individual- and population-level health consequences, and obesity as a socially undesirable, stigmatizing construct opposing thinness as the healthy ideal. Less often considered is the role of Body Mass Index (BMI) as the standard by which obesity and healthy weight are measured and defined. Addressing this issue, I begin by distinguishing between BMI as an empirical, objective measure of health, and BMI as an arbitrary, subjective label for categorizing the population. I further consider how BMI is empowered as a measurable quantity through the lens of medicalization and evidence-based medicine, and introduce the "performativity" of BMI as a superior framework for confronting the measure's conceptual limitations. Emphasizing key parallels between BMI and self-rated health as measures with high predictive validity, yet unspecified mechanisms of action, I propose an epistemological shift away from classifying BMI as a biomarker and toward a more flexible view of the measure as a holistic appraisal of health. In closing, I argue that researchers may continue to leverage BMI's ease of collection and interpretation, provided they are attuned to its definitional ambiguity across diverse research methods and contexts.
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Affiliation(s)
- Iliya Gutin
- The University of North Carolina-Chapel Hill, 155 Hamilton Hall, Chapel Hill, NC 27514
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Abstract
Mycobacterium bovis, the bacterium responsible for causing bovine tuberculosis (bTB) in cattle, displays what I call ‘microbial performativity’. Like many other lively disease-causing microorganisms, it has an agency which is difficult to contain, and there is a need for fresh thinking on the challenges of dealing with this slippery and indeterminate microbe. As a practising veterinary scientist who side-stepped mid-career into a parallel training in the social sciences to view bTB from an alternative perspective, I create an interdisciplinary coming-together where veterinary science converges with a political ecology of (animal) health influenced by science and technology studies (STS) and social science and humanities scholarship on performativity. This suitably hybridized nexus creates a place to consider the ecologies of a pathogen which could be considered as life out of control. I consider what this means for efforts to eradicate this disease through combining understandings from the published scientific literature with qualitative interview-based fieldwork with farmers, veterinarians and others involved in the statutory bTB eradication programme in a high incidence region of the UK. This study demonstrates the value of life scientists turning to the social sciences to re-view their familiar professional habitus—challenging assumptions, and offering alternative perspectives on complex problems.
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Abstract
Purpose The purpose of this paper is to explore a possible discursive history of National Health Service (NHS) "management" (with management, for reasons that will become evident, very much in scare quotes). Such a history is offered as a complement, as well as a counterpoint, to the more traditional approaches that have already been taken to the history of the issue. Design/methodology/approach Document analysis and interviews with UK NHS trust chief executives. Findings After explicating the assumptions of the method it suggests, through a range of empirical sources that the NHS has undergone an era of administration, an era of management and an era of leadership. Research limitations/implications The paper enables a recasting of the history of the NHS; in particular, the potential for such a discursive history to highlight the interests supported and denied by different representational practices. Practical implications Today's so-called leaders are leaders because of conventional representational practices - not because of some essence about what they really are. Social implications New ideas about the nature of management. Originality/value The value of thinking in terms of what language does - rather than what it might represent.
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Affiliation(s)
- Mark Learmonth
- Durham University Business School, Durham University , Durham, UK
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Essén A, Oborn E. The performativity of numbers in illness management: The case of Swedish Rheumatology. Soc Sci Med 2017; 184:134-143. [PMID: 28525782 DOI: 10.1016/j.socscimed.2017.05.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 05/05/2017] [Accepted: 05/09/2017] [Indexed: 11/24/2022]
Abstract
While there is a proliferation of numerical data in healthcare, little attention has been paid to the role of numbers in constituting the healthcare reality they are intended to depict. This study explores the performativity of numbers in the microlevel management of rheumatoid disease. We draw on a study of patients' and physicians' use of the numbers in the Swedish Rheumatology Quality Registry, conducted between 2009 and 2014. We show how the numbers performed by constructing the disease across time, and by framing action. The numerical performances influenced patients and physicians in different ways, challenging the former to quantify embodied disease and the latter to subsume the disease into one of many possible trajectory standards. Based on our findings, we provide a model of the dynamic performativity of numbers in the on-going management of illness. The model conceptualises how numbers generate new possibilities; by creating tension and alignment they may open up new avenues for communication between patients and physicians.
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Affiliation(s)
- Anna Essén
- Stockholm School of Economics Institute for Research, Saltmätargatan 13-17, 113 83 Stockholm, Sweden; Medical Management Centre, LIME, Karolinska Institutet Stockholm, Sweden.
| | - Eivor Oborn
- Warwick Business School, The University of Warwick, Coventry, CV4 7AL, UK.
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Abstract
A performance-based funding system like the United Kingdom's 'Research Excellence Framework' (REF) symbolizes the re-rationalization of higher education according to neoliberal ideology and New Public Management technologies. The REF is also significant for disclosing the kinds of behaviour that characterize universities' response to government demands for research auditability. In this paper, we consider the casualties of what Henry Giroux (2014) calls "neoliberalism's war on higher education" or more precisely the deleterious consequences of non-participation in the REF. We also discuss the ways with which higher education's competition fetish, embodied within the REF, affects the instrumentalization of academic research and the diminution of academic freedom, autonomy and criticality.
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Affiliation(s)
- Richard Watermeyer
- />Department of Education, University of Bath, Claverton Down, Bath, BA2 7AY UK
| | - Mark Olssen
- />School of Social Sciences, University of Surrey, Guildford, GU2 7XH UK
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Abstract
The growing popularity of relational approaches to agency amongst archaeologists has led to increased attention on the specific contexts of interaction between humans and their material worlds. Within such viewpoints, non-humans are perceived as agents in their own right and placed on an equal footing with humans, with both acting to generate social categories in past cultures. However, to date, the focus of these interpretative models has been overwhelmingly directed towards inanimate objects. Animals are generally absent from these discussions, despite their ubiquity in past societies and the frequently central roles they held within daily lives and social relations. Moreover, living animals are set apart from material culture because, like humans, they are usually aware of their environs and are capable of physically responding to them. This ability to 'act back' would have made human-animal interactions extremely dynamic and thus offers different conceptual challenges to archaeologists than when faced with objects. This paper demonstrates that the notion of performativity, combined with understanding of animals themselves, can help to comprehend these relations. It does so by focusing on one particular species, the domestic cat, in relation to Anglo-Saxon England. The characteristics and behaviour of these animals affected the ways in which humans perceived and interacted with them, so that just one individual cat could be categorised in a range of different ways. The classification of animals was thus just as fluid, if not more so, as that of objects and highlights the need to incorporate the former into reconstructions of the social in archaeological research.
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Affiliation(s)
- Kristopher Poole
- Department of Archaeology, University of Nottingham, Humanities Building, University Park, Nottingham, NG7 2RD UK
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