AbstractBackgroundPerson-centred care (PCC) is increasingly advocated as a new way of delivering ... more AbstractBackgroundPerson-centred care (PCC) is increasingly advocated as a new way of delivering health care, but there is little evidence that it is widely practised. The University of Gothenburg Centre for Person-Centred Care (GPCC) was set up in 2010 to develop and implement person-centred care in clinical practice on the basis of three routines. These routines are based on eliciting the patient's narrative to initiate a partnership; working the partnership to achieve commonly agreed goals; and using documentation to safeguard the partnership and record the person's narrative and shared goals.ObjectiveIn this paper, we aimed to explore professionals' understanding of PCC routines as they implement the GPCC model in a range of different settings.MethodsWe conducted a qualitative study and interviewed 18 clinician-researchers from five health-care professions who were working in seven diverse GPCC projects.ResultsInterviewees’ accounts of PCC emphasized the ways in which persons are seen as different from patients; the variable emphasis placed on the person's goals; and the role of the person's own resources in building partnerships.ConclusionThis study illustrates what is needed for health-care professionals to implement PCC in everyday practice: the recognition of the person is as important as the specific practical routines. Interviewees described the need to change the clinical mindset and to develop the ways of integrating people's narratives with clinical practice.
In recent decades, the ‘tenacious assumptions’ of biomedicine regarding the neutrality and univer... more In recent decades, the ‘tenacious assumptions’ of biomedicine regarding the neutrality and universality of its knowledge claims have been significantly challenged by the growth of new collaborative and patient-focused models of Healthcare delivery. In this article, we discuss and critically reflect upon one such alternative Healthcare model developed at the University of Gothenburg Centre for Person-Centred Care in Sweden. This centre uses three clinical routines of narrative, partnership and documentation to provide Healthcare to people recognized as unique individuals rather than patients. Person-centred care in Gothenburg and more broadly is based on the assumption that a person is independently capable of reasoning and verbal expression and willing to provide clear and genuine narratives and cooperate with Healthcare professionals. However, we argue that by emphasizing individual capabilities of reasoning and verbal expression, an unnecessarily limited conception of personhood risks being imposed on these routines. Drawing upon semi-structured interviews with researchers in three very different Gothenburg Centre for Person-Centred Care research projects – about healthy ageing in migrant communities, neurogenic communication disorders, and psychosis – we highlight that how persons are recognized as unique and capable varies significantly in practice across different Healthcare settings. Thus, we assert that person-centred care’s own potentially tenacious assumptions about the attributes of personhood risk distracting attention away from the variety of creative ways that professionals and persons promisingly find for translating the ideal of person-centred care into practice.
AbstractBackgroundTo empower patients and improve the quality of care, policy-makers increasingly... more AbstractBackgroundTo empower patients and improve the quality of care, policy-makers increasingly adopt systems to enhance person-centred care. Although models of person-centredness and patient-centredness vary, respecting the needs and preferences of individuals receiving care is paramount. In Sweden, as in other countries, healthcare providers seek to improve person-centred principles and address gaps in practice. Consequently, researchers at the University of Gothenburg Centre for Person-Centred Care are currently delivering person-centred interventions employing a framework that incorporates three routines. These include eliciting the patient's narrative, agreeing a partnership with shared goals between patient and professional, and safeguarding this through documentation.AimTo explore the barriers and facilitators to the delivery of person-centred care interventions, in different contexts.MethodQualitative interviews were conducted with a purposeful sample of 18 researchers from seven research studies across contrasting healthcare settings. Interviews were transcribed, translated and thematically analysed, adopting some basic features of grounded theory.Ethical issuesThe ethical code of conduct was followed and conformed to the ethical guidelines adopted by the Swedish Research Council.ResultsBarriers to the implementation of person-centred care covered three themes: traditional practices and structures; sceptical, stereotypical attitudes from professionals; and factors related to the development of person-centred interventions. Facilitators included organisational factors, leadership and training and an enabling attitude and approach by professionals. Trained project managers, patients taking an active role in research and adaptive strategies by researchers all helped person-centred care delivery.ConclusionAt the University of Gothenburg, a model of person-centred care is being initiated and integrated into practice through research. Knowledgeable, well-trained professionals facilitate the routines of narrative elicitation and partnership. Strong leadership and adaptive strategies are important for overcoming existing practices, routines and methods of documentation. This study provides guidance for practitioners when delivering and adapting person-centred care in different contexts.
International Journal of Drug Policy 26 - http://www.ijdp.org/article/S0955-3959(15)00044-4/abstract, Mar 2015
Background: E-cigarettes are currently hotly debated as threatening to re-normalize cigarette smo... more Background: E-cigarettes are currently hotly debated as threatening to re-normalize cigarette smokingand make nicotine addiction publicly acceptable once more. In this paper I contextualize the e-cigarette controversy in light of longstanding disagreements about the meaning and significance of nicotine replacement technologies. A concerted effort to develop such technologies first emerged in Sweden at theend of the 1960s, embodying a vital tension. Two competing ‘scripts’ vied to influence and shape inno-vative designs. On the one hand, Nicorette chewing gum was conceived as a therapeutic device aidingsmoking cessation. On the other hand, it was cast as a cigarette substitute designed to deliver nicotine ‘inthe right way’, thereby advancing the creative destruction of the combustible cigarette as a drug delivery platform. Method: Drawing on historical and archival research I outline how these two alternative innovation scripts started out entangled with each other before becoming disentangled, leading to the eventual stabilization of Nicorette gum as a therapeutic product to be deployed in the treatment of smoking as adependence disorder. Results and Conclusion: While a post-therapeutic future for nicotine replacement was charted by Michael Russell at the beginning of the 1990s, it is only with the rise of e-cigarettes after 2003 that such a futurehas started to verge on reality. E-cigarettes can be seen as resurrecting the historically marginalized script of nicotine replacement as dedicated to righting nicotine consumption and freeing it from the wrongful drug delivery of the modern cigarette.
AIM – To discuss how scientific confirmation of cigarette smoking as a major contemporary drug pr... more AIM – To discuss how scientific confirmation of cigarette smoking as a major contemporary drug problem during the 1980s was preceded by a rising tide of clinical and pharmaceutical innovation dedicated to treating smoking as a problem of addiction.
BACKGROUND – This current of innovation, commencing already in the 1950s, carried the smokers’ clinic and nicotine replacement therapies (NRTs) into the world, both of which were originally invented and pioneered in Sweden. It
is argued that both of these inventions were vital for advancing the problematization of smoking as
a matter of nicotine addiction. While the British doctor Lennox Johnston is well-known for his early attempts to demonstrate the reality of smoking as nicotine addiction through auto-experimentation, the historical significance of Börje Ejrup’s founding of the first smokers’ clinics in Stockholm in the late 1950s has not been widely commented upon. Attempting to remedy this situation, the rise and fall of Ejrup’s clinics deploying lobeline substitution therapy as a cure for ‘nicotinism’ is outlined in the main body of the paper. FINDINGS – Although the clinical treatment of smoking as
addiction lost momentum during the 1960s, the invention of Nicorette gum in southern Sweden at the end of the decade provided renewed impetus. Commencing in Helsingborg and Lund in 1970, the smokers’ clinic and NRTs entered into the long-term service of each other; a new combination
that in just over a decade would succeed in propagating the reality of smoking as nicotine addiction
on to a global stage.
In Blok, A. and Gundelach, P. (eds) The Elementary Forms of Sociological Knowledge. Essays in Honour of Margareta Bertilsson, 2014
To speak of nicotine replacement today is to speak of nicotine replacement therapies (NRTs) used ... more To speak of nicotine replacement today is to speak of nicotine replacement therapies (NRTs) used throughout the world in the treatment of smoking conceived as a manifestation of nicotine addiction. However, I wish to discuss how the logic of nicotine replacement has never been purely a question of therapeutic innovation. By returning to the Swedish birth of NRTs at the end of the 1960s and the original entrepreneurial vision of Nicorette as the delivery of nicotine (nico-) in the right (rette) way I wish to show how things could so easily have been different in the development of nicotine chewing gum as the first NRT. Drawing on a range of sources, including material from the historical archives of the Helsingborg-based pharmaceutical company that brought Nicorette® chewing gum into the world, I wish to discuss how the political and technological tensions inherent in the governmental logic of nicotine replacement have continually pulled new replacement technologies in different directions.
In recent decades, addiction has been medicalized anew through the rise of an influential ‘brain ... more In recent decades, addiction has been medicalized anew through the rise of an influential ‘brain disease paradigm’. This questions the equivalence of addiction to drug dependence by re-emphasizing loss of self-control over unhealthy impulses as the disease locus. While showing continuities with the nineteenth-century vision of addictions as ‘diseases of the will’, neurobiology objectifies disease as disrupted neurochemical transmission and lasting neuroadaptation. The brain disease paradigm emerged together with rapid advances in neuroimaging technology as well as intensified research efforts to confirm cigarette smoking as nicotine addiction. After smoking achieved such recognition in the late 1980s, numerous other unhealthy impulses and appetites have likewise come under neurobiological investigation as prospective cases of addiction. Despite its technoscientific sophistication, neurobiology's biomedicalization of addiction remains as partial and ambiguous as past medicalizations. By confirming moral self-transformation anew as an indispensable component of treatment and recovery, neurobiology revives addiction as a moral disease in the process of its objectification. Furthermore, through its rediscovery of a classic nineteenth-century ‘liberal disease’ at the molecular level, the neurobiology of addiction is acting as a vital moralizing resource in the biomedicalization of health and illness more generally today.
Advances in Medical Sociology 14 - Critical Perspectives on Addiction. Edited by Netherland, J., 2012
Purpose – With reference to the long-term struggle to confirm cigarette smoking as a manifestatio... more Purpose – With reference to the long-term struggle to confirm cigarette smoking as a manifestation of nicotine addiction, this chapter explores the extent to which new understandings of addictions as ‘appetitive disorders’ rather than ‘dependence disorders’ derive from treatment technology development as well as advances in basic scientific research.
Approach – Through historical analysis it is discussed how cigarette smoking only became widely accepted as a real drug problem in the 1980s after it had been shown to be amenable to treatment as such through the use of novel nicotine replacement therapies.
Findings – These replacement therapies succeeded in showing that the same drug that drew users into addiction could be redeployed to help draw up them out of it. Nicorette® could serve as at least the partial antidote to nico-wrong (cigarettes). However, as relapse to smoking has remained the most likely outcome of any smoking cessation attempt, so medicinal nicotine has also served to demonstrate that nicotine addiction is ultimately a problem of an uncontrollable appetite for cigarettes in excess of drug dependence.
Implications – Pharmaceutical incursion on cigarette smoking commencing in the late 1970s pointed to the need for a new mental disease model of drug-related problems while also providing valuable new tools and insights for ensuing brain research.
This paper deals with the second coming of tobacco harm reduction, gradually gaining momentum aft... more This paper deals with the second coming of tobacco harm reduction, gradually gaining momentum after 1990, and centring on a moist oral tobacco product from Sweden called snus. The idea of snus and other ’smokeless’ tobacco products as significant harm reducers has grown in stature as the ’smoking epidemic’ has been more firmly established as a manifestation of nicotine addiction. People smoke for nicotine, it is argued, but risk death firstly due to exposure to the many other toxins found in cigarette smoke. This suggests that to effectively reduce tobacco-related mortality, the development of alternative smoke-free nicotine delivery systems should be prioritized. The paper points to the importance of the 1992 EU ban on the sale of snus outside of Sweden for having enlarged debate about the ’Swedish experience’ of snus consumption. Growing international interest in snus is contrasted with staunch domestic opposition to smokeless tobacco harm reduction coming from a Swedish public health community still committed to the vision of a ’drug-free society’. At the end of the paper, the role of smokeless tobacco harm reduction in reframing the identity of medicinal nicotine is discussed. As tobacco and pharmaceutical companies both dedicate themselves to developing new smokeless drug delivery systems, so the original kinship between oral tobacco and medicinal nicotine grows ever more apparent. This kinship is particularly noticeable in Sweden which, despite its ’drug-free’ pretensions, currently resembles the promised land of ’clean nicotine’.
Actor–network theory and the notion of fluid technology are employed to account for the continuin... more Actor–network theory and the notion of fluid technology are employed to account for the continuing and growing success of Swedish nuclear waste management (the so-called KBS Programme). Rather than offering a single, constant geological solution, Swedish success is based upon three forms of fluidity: the attachment of shifting meanings and significance to the geological disposal of nuclear waste; the introduction of variations in the working order of geological disposal; and the continuing pliancy of the implementing authority. By remaining fluid, Swedish nuclear waste management has enjoyed growing success not necessarily by bringing us
closer to a long-term solution of the nuclear waste problem, but by upholding and developing its capacity to demonstrate that such a solution remains within sight and practical reach.
This paper addresses the long-standing association between the management of spent nuclear fuel i... more This paper addresses the long-standing association between the management of spent nuclear fuel in Sweden and the industry-led KBS (Kärnbränslesäkerhet/Nuclear Fuel Safety) research, development and demonstration project. This
project was born under extraordinary circumstances during the 1970s when the future of nuclear power generation in Sweden was made conditional upon the nuclear industry’s ability to publicly demonstrate the possibility of achieving
‘absolute’ nuclear fuel safety. Due to the success of the KBS project in bringing controversy to an end, and in winning the stamp of government approval for successive versions of its KBS concept, the achievement of nuclear fuel safety in
Sweden has, for approaching 25 years now, centred on the stepwise implementation of the multi-barrier KBS-3 concept for the direct geological disposal of the nation’s spent nuclear fuel. While the KBS-3 concept can be seen as representing a long-run victory of nuclear waste technology over conflictual
nuclear politics in Sweden, this victory has remained incomplete so long as a site for a deep repository and the materialisation of the concept has remained undecided. Since 2002, the siting process has been re-centred on the KBS project’s two historically preferred sites where Sweden’s existing nuclear waste facilities are already clustered. As will be discussed in this paper, just when the KBS-3 concept appears close to fully materialising itself, it has run into yet another serious hurdle and an Environmental Impact Assessment process in respect of the Swedish Environmental Code – comprehensive environmental legislation introduced in 1999, more than 20 years after the KBS project was initiated. In facing this latest hurdle, it is becoming increasingly apparent that KBS-3, through the recent internationalisation of the Swedish nuclear industry, has outgrown its identity as a national solution to nuclear fuel safety, and is on the verge of mutating into a global platform in spent fuel/high-level waste management practice and technology.
Risk, Hazards and Crisis in Public Policy 1(4), Nov 2010
In this paper we critically evaluate contemporary processes of public involvement in nuclear acti... more In this paper we critically evaluate contemporary processes of public involvement in nuclear activities in Europe. Our focus is two collaborative “technology platforms” at the European level, one for implementing the geological disposal of nuclear waste, the other for rendering nuclear energy sustainable. In key documents and statements connected with the launching of these two platforms, public participation is assigned a vital role in their construction. While participation is presented in both cases as important for heightening the legitimacy of national nuclear industry programs and creating more room for public influence, the nature of this participation tends to remain obscure. From our analysis of the European Union documents and statements, informed by recent discussions in science and technology studies (STS), we conclude that “the participatory turn” in the nuclear sector focuses too strongly on procedural matters—on public involvement as a good in itself—while deflecting attention away from the possibilities of using participation as a more genuine means of enabling public issues and concerns to reach a higher level of articulation. Attempting to resolve legitimacy problems by conceiving of public participation as a way of maneuvering around public concerns is problematic since the latter must be more properly conceived as remaining the foundation for the former. If the issues calling for enlarged public participation in nuclear activities in Europe were awarded greater attention, then the legitimacy of these activities might indeed be improved. It can be imagined, for example, that the connections between the disposal of legacy wastes and the authorization of new build would be rendered more transparent.
As the distance between science and society is collapsed with the growth of contemporary knowledg... more As the distance between science and society is collapsed with the growth of contemporary knowledge societies, so a range of different approaches to the democratic governance of science superseding its Enlightenment government is emerging. In light of these different approaches, this article
focuses on the figure of the scientific citizen and the variable dimensions of a new scientific citizenship. Three models of democracy – advanced consumer, deliberative and radical/pluralist – are put forward as both partly
competing and partly complementary frameworks within which the new rights and responsibilities of the scientific citizen can be articulated and discussed. In each case the theory and practice of scientific citizenship are
viewed against the background of contemporary developments within the field of science communication; the rise of the public understanding of science movement; the new enthusiasm for advancing public engagements
with science, and the legitimate place of different forms of public protest and dissent within new designs for democratic governance.
Science popularisation is widely recognised as having its ‘political uses’ and as serving as a co... more Science popularisation is widely recognised as having its ‘political uses’ and as serving as a conventional means for buttressing the epistemic authority of the institutions of science in society. By separating the work of producing new knowledge from its dissemination, popularisation promotes public understanding and appreciation of science placed beyond public reach and influence. However, simply by insisting upon such a separation, so popularisation remains vulnerable to ‘capture’ by skilled and resourceful communicators intent on turning it against the established authority of scientists. This is a phenomenon which can be analysed in relation to the communicative strategies pursued by a collection of general practitioners, diabetics and self-styled dietary experts in Sweden championing a low-carbohydrate/high fat (LCHF) dietetics akin to the Diet Revolution initiated by Robert Atkins in the early 1970s. By dedicating themselves to achieving an overwhelming public presence in the propagation of simplified accounts of dietary science, the LCHF movement has been able to fashion science popularisation into a weapon capable of being turned back upon established dietary expertise in Sweden. In this effort they have proceeded on two fronts; firstly by debunking established dietary advice for failing to live up to idealised standards of ‘sound science’, and secondly, by effectively mobilising the personal testimony and endorsements of dieters themselves in order to publicly confirm the authenticity and trustworthiness of the LCHF regimen.
The new interest in staging public engagements with science, and the biosciences in particular, h... more The new interest in staging public engagements with science, and the biosciences in particular, has been widely associated with a 'democratic turn' in the public understanding of science movement. This article seeks to bring this association under closer scrutiny by focusing on the development of public engagement with biotechnology in Sweden. It analyses the production and dramatic composition of a two-part film documentary entitled Life at Stake, financed by the Swedish research community and broadcast on public service television. Particular attention is paid to the actions of the new non-profit organization Scientists Meet Film-Makers, and the crucial mediating role this organization played in creating the conditions of possibility for Life at Staketo be financed, produced and broadcast. In conclusion, rather than supporting a new logic of deliberation, Life at Stake is discussed as more concerned with symbolization and spectacle in its use of images of suffering and hope as the touchstone of truth about biotechnology in society. In this way, science communicators appear to be displaying a willingness to learn from the media practices of environmental organizations and other protest groups, who have long appreciated the importance of contesting symbolic codes and schemes of meaning in society.
Studies of digitally mediated learning, knowing, and expertise have been at the core of many rese... more Studies of digitally mediated learning, knowing, and expertise have been at the core of many research endeavors in recent years. Central to this effort are investigations focusing on gaining concrete insights into how the trans-disciplinary affordances of digital media are reconfiguring the established worlds of research, education, professional practice, and everyday life. While we generally seem to quite easily engage with and adapt to the media ecologies of our time, new digital tools and methods and the co-evolution of socio-cultural practices is also opening the way for new collaborative arrangements and cooperative efforts where, for example, patients become partners in their own care and treatment; ordinary citizens are mobilized in basic research; visitors participate in co-designing their museum experience; and students produce advanced visualizations of technoscientific controversies. In the face of such novel arrangements, researchers are increasingly being asked to both investigate and design new worlds of digital inquiry. So, while researchers are exploring how digital technologies are entangled in practices and processes of learning, their own methodological and analytical practices are being transformed by the very same digital innovations they are studying. One could say our research activities are contributing to envisioning and designing new worlds of experimentation and inquiry. This seminar accordingly aims to contribute to theoretical and methodological issues of studying and intervening in practices of learning and knowing in transformation. We seek to do this by drawing on generic or specific features of our trans-disciplinary studies of digital engagements across different kinds of practices and socio-technical configurations. The kind of studies we have in mind work in close collaboration with the people studied and their communities, i.e. projects are arranged through co-design. Or they reach across both disciplinary and professional boundaries and collaborate around the production as well as analysis of data. Relevant studies may also adopt the digital tools and methods they explore and incorporate them into their analytical approaches.
AbstractBackgroundPerson-centred care (PCC) is increasingly advocated as a new way of delivering ... more AbstractBackgroundPerson-centred care (PCC) is increasingly advocated as a new way of delivering health care, but there is little evidence that it is widely practised. The University of Gothenburg Centre for Person-Centred Care (GPCC) was set up in 2010 to develop and implement person-centred care in clinical practice on the basis of three routines. These routines are based on eliciting the patient's narrative to initiate a partnership; working the partnership to achieve commonly agreed goals; and using documentation to safeguard the partnership and record the person's narrative and shared goals.ObjectiveIn this paper, we aimed to explore professionals' understanding of PCC routines as they implement the GPCC model in a range of different settings.MethodsWe conducted a qualitative study and interviewed 18 clinician-researchers from five health-care professions who were working in seven diverse GPCC projects.ResultsInterviewees’ accounts of PCC emphasized the ways in which persons are seen as different from patients; the variable emphasis placed on the person's goals; and the role of the person's own resources in building partnerships.ConclusionThis study illustrates what is needed for health-care professionals to implement PCC in everyday practice: the recognition of the person is as important as the specific practical routines. Interviewees described the need to change the clinical mindset and to develop the ways of integrating people's narratives with clinical practice.
In recent decades, the ‘tenacious assumptions’ of biomedicine regarding the neutrality and univer... more In recent decades, the ‘tenacious assumptions’ of biomedicine regarding the neutrality and universality of its knowledge claims have been significantly challenged by the growth of new collaborative and patient-focused models of Healthcare delivery. In this article, we discuss and critically reflect upon one such alternative Healthcare model developed at the University of Gothenburg Centre for Person-Centred Care in Sweden. This centre uses three clinical routines of narrative, partnership and documentation to provide Healthcare to people recognized as unique individuals rather than patients. Person-centred care in Gothenburg and more broadly is based on the assumption that a person is independently capable of reasoning and verbal expression and willing to provide clear and genuine narratives and cooperate with Healthcare professionals. However, we argue that by emphasizing individual capabilities of reasoning and verbal expression, an unnecessarily limited conception of personhood risks being imposed on these routines. Drawing upon semi-structured interviews with researchers in three very different Gothenburg Centre for Person-Centred Care research projects – about healthy ageing in migrant communities, neurogenic communication disorders, and psychosis – we highlight that how persons are recognized as unique and capable varies significantly in practice across different Healthcare settings. Thus, we assert that person-centred care’s own potentially tenacious assumptions about the attributes of personhood risk distracting attention away from the variety of creative ways that professionals and persons promisingly find for translating the ideal of person-centred care into practice.
AbstractBackgroundTo empower patients and improve the quality of care, policy-makers increasingly... more AbstractBackgroundTo empower patients and improve the quality of care, policy-makers increasingly adopt systems to enhance person-centred care. Although models of person-centredness and patient-centredness vary, respecting the needs and preferences of individuals receiving care is paramount. In Sweden, as in other countries, healthcare providers seek to improve person-centred principles and address gaps in practice. Consequently, researchers at the University of Gothenburg Centre for Person-Centred Care are currently delivering person-centred interventions employing a framework that incorporates three routines. These include eliciting the patient's narrative, agreeing a partnership with shared goals between patient and professional, and safeguarding this through documentation.AimTo explore the barriers and facilitators to the delivery of person-centred care interventions, in different contexts.MethodQualitative interviews were conducted with a purposeful sample of 18 researchers from seven research studies across contrasting healthcare settings. Interviews were transcribed, translated and thematically analysed, adopting some basic features of grounded theory.Ethical issuesThe ethical code of conduct was followed and conformed to the ethical guidelines adopted by the Swedish Research Council.ResultsBarriers to the implementation of person-centred care covered three themes: traditional practices and structures; sceptical, stereotypical attitudes from professionals; and factors related to the development of person-centred interventions. Facilitators included organisational factors, leadership and training and an enabling attitude and approach by professionals. Trained project managers, patients taking an active role in research and adaptive strategies by researchers all helped person-centred care delivery.ConclusionAt the University of Gothenburg, a model of person-centred care is being initiated and integrated into practice through research. Knowledgeable, well-trained professionals facilitate the routines of narrative elicitation and partnership. Strong leadership and adaptive strategies are important for overcoming existing practices, routines and methods of documentation. This study provides guidance for practitioners when delivering and adapting person-centred care in different contexts.
International Journal of Drug Policy 26 - http://www.ijdp.org/article/S0955-3959(15)00044-4/abstract, Mar 2015
Background: E-cigarettes are currently hotly debated as threatening to re-normalize cigarette smo... more Background: E-cigarettes are currently hotly debated as threatening to re-normalize cigarette smokingand make nicotine addiction publicly acceptable once more. In this paper I contextualize the e-cigarette controversy in light of longstanding disagreements about the meaning and significance of nicotine replacement technologies. A concerted effort to develop such technologies first emerged in Sweden at theend of the 1960s, embodying a vital tension. Two competing ‘scripts’ vied to influence and shape inno-vative designs. On the one hand, Nicorette chewing gum was conceived as a therapeutic device aidingsmoking cessation. On the other hand, it was cast as a cigarette substitute designed to deliver nicotine ‘inthe right way’, thereby advancing the creative destruction of the combustible cigarette as a drug delivery platform. Method: Drawing on historical and archival research I outline how these two alternative innovation scripts started out entangled with each other before becoming disentangled, leading to the eventual stabilization of Nicorette gum as a therapeutic product to be deployed in the treatment of smoking as adependence disorder. Results and Conclusion: While a post-therapeutic future for nicotine replacement was charted by Michael Russell at the beginning of the 1990s, it is only with the rise of e-cigarettes after 2003 that such a futurehas started to verge on reality. E-cigarettes can be seen as resurrecting the historically marginalized script of nicotine replacement as dedicated to righting nicotine consumption and freeing it from the wrongful drug delivery of the modern cigarette.
AIM – To discuss how scientific confirmation of cigarette smoking as a major contemporary drug pr... more AIM – To discuss how scientific confirmation of cigarette smoking as a major contemporary drug problem during the 1980s was preceded by a rising tide of clinical and pharmaceutical innovation dedicated to treating smoking as a problem of addiction.
BACKGROUND – This current of innovation, commencing already in the 1950s, carried the smokers’ clinic and nicotine replacement therapies (NRTs) into the world, both of which were originally invented and pioneered in Sweden. It
is argued that both of these inventions were vital for advancing the problematization of smoking as
a matter of nicotine addiction. While the British doctor Lennox Johnston is well-known for his early attempts to demonstrate the reality of smoking as nicotine addiction through auto-experimentation, the historical significance of Börje Ejrup’s founding of the first smokers’ clinics in Stockholm in the late 1950s has not been widely commented upon. Attempting to remedy this situation, the rise and fall of Ejrup’s clinics deploying lobeline substitution therapy as a cure for ‘nicotinism’ is outlined in the main body of the paper. FINDINGS – Although the clinical treatment of smoking as
addiction lost momentum during the 1960s, the invention of Nicorette gum in southern Sweden at the end of the decade provided renewed impetus. Commencing in Helsingborg and Lund in 1970, the smokers’ clinic and NRTs entered into the long-term service of each other; a new combination
that in just over a decade would succeed in propagating the reality of smoking as nicotine addiction
on to a global stage.
In Blok, A. and Gundelach, P. (eds) The Elementary Forms of Sociological Knowledge. Essays in Honour of Margareta Bertilsson, 2014
To speak of nicotine replacement today is to speak of nicotine replacement therapies (NRTs) used ... more To speak of nicotine replacement today is to speak of nicotine replacement therapies (NRTs) used throughout the world in the treatment of smoking conceived as a manifestation of nicotine addiction. However, I wish to discuss how the logic of nicotine replacement has never been purely a question of therapeutic innovation. By returning to the Swedish birth of NRTs at the end of the 1960s and the original entrepreneurial vision of Nicorette as the delivery of nicotine (nico-) in the right (rette) way I wish to show how things could so easily have been different in the development of nicotine chewing gum as the first NRT. Drawing on a range of sources, including material from the historical archives of the Helsingborg-based pharmaceutical company that brought Nicorette® chewing gum into the world, I wish to discuss how the political and technological tensions inherent in the governmental logic of nicotine replacement have continually pulled new replacement technologies in different directions.
In recent decades, addiction has been medicalized anew through the rise of an influential ‘brain ... more In recent decades, addiction has been medicalized anew through the rise of an influential ‘brain disease paradigm’. This questions the equivalence of addiction to drug dependence by re-emphasizing loss of self-control over unhealthy impulses as the disease locus. While showing continuities with the nineteenth-century vision of addictions as ‘diseases of the will’, neurobiology objectifies disease as disrupted neurochemical transmission and lasting neuroadaptation. The brain disease paradigm emerged together with rapid advances in neuroimaging technology as well as intensified research efforts to confirm cigarette smoking as nicotine addiction. After smoking achieved such recognition in the late 1980s, numerous other unhealthy impulses and appetites have likewise come under neurobiological investigation as prospective cases of addiction. Despite its technoscientific sophistication, neurobiology's biomedicalization of addiction remains as partial and ambiguous as past medicalizations. By confirming moral self-transformation anew as an indispensable component of treatment and recovery, neurobiology revives addiction as a moral disease in the process of its objectification. Furthermore, through its rediscovery of a classic nineteenth-century ‘liberal disease’ at the molecular level, the neurobiology of addiction is acting as a vital moralizing resource in the biomedicalization of health and illness more generally today.
Advances in Medical Sociology 14 - Critical Perspectives on Addiction. Edited by Netherland, J., 2012
Purpose – With reference to the long-term struggle to confirm cigarette smoking as a manifestatio... more Purpose – With reference to the long-term struggle to confirm cigarette smoking as a manifestation of nicotine addiction, this chapter explores the extent to which new understandings of addictions as ‘appetitive disorders’ rather than ‘dependence disorders’ derive from treatment technology development as well as advances in basic scientific research.
Approach – Through historical analysis it is discussed how cigarette smoking only became widely accepted as a real drug problem in the 1980s after it had been shown to be amenable to treatment as such through the use of novel nicotine replacement therapies.
Findings – These replacement therapies succeeded in showing that the same drug that drew users into addiction could be redeployed to help draw up them out of it. Nicorette® could serve as at least the partial antidote to nico-wrong (cigarettes). However, as relapse to smoking has remained the most likely outcome of any smoking cessation attempt, so medicinal nicotine has also served to demonstrate that nicotine addiction is ultimately a problem of an uncontrollable appetite for cigarettes in excess of drug dependence.
Implications – Pharmaceutical incursion on cigarette smoking commencing in the late 1970s pointed to the need for a new mental disease model of drug-related problems while also providing valuable new tools and insights for ensuing brain research.
This paper deals with the second coming of tobacco harm reduction, gradually gaining momentum aft... more This paper deals with the second coming of tobacco harm reduction, gradually gaining momentum after 1990, and centring on a moist oral tobacco product from Sweden called snus. The idea of snus and other ’smokeless’ tobacco products as significant harm reducers has grown in stature as the ’smoking epidemic’ has been more firmly established as a manifestation of nicotine addiction. People smoke for nicotine, it is argued, but risk death firstly due to exposure to the many other toxins found in cigarette smoke. This suggests that to effectively reduce tobacco-related mortality, the development of alternative smoke-free nicotine delivery systems should be prioritized. The paper points to the importance of the 1992 EU ban on the sale of snus outside of Sweden for having enlarged debate about the ’Swedish experience’ of snus consumption. Growing international interest in snus is contrasted with staunch domestic opposition to smokeless tobacco harm reduction coming from a Swedish public health community still committed to the vision of a ’drug-free society’. At the end of the paper, the role of smokeless tobacco harm reduction in reframing the identity of medicinal nicotine is discussed. As tobacco and pharmaceutical companies both dedicate themselves to developing new smokeless drug delivery systems, so the original kinship between oral tobacco and medicinal nicotine grows ever more apparent. This kinship is particularly noticeable in Sweden which, despite its ’drug-free’ pretensions, currently resembles the promised land of ’clean nicotine’.
Actor–network theory and the notion of fluid technology are employed to account for the continuin... more Actor–network theory and the notion of fluid technology are employed to account for the continuing and growing success of Swedish nuclear waste management (the so-called KBS Programme). Rather than offering a single, constant geological solution, Swedish success is based upon three forms of fluidity: the attachment of shifting meanings and significance to the geological disposal of nuclear waste; the introduction of variations in the working order of geological disposal; and the continuing pliancy of the implementing authority. By remaining fluid, Swedish nuclear waste management has enjoyed growing success not necessarily by bringing us
closer to a long-term solution of the nuclear waste problem, but by upholding and developing its capacity to demonstrate that such a solution remains within sight and practical reach.
This paper addresses the long-standing association between the management of spent nuclear fuel i... more This paper addresses the long-standing association between the management of spent nuclear fuel in Sweden and the industry-led KBS (Kärnbränslesäkerhet/Nuclear Fuel Safety) research, development and demonstration project. This
project was born under extraordinary circumstances during the 1970s when the future of nuclear power generation in Sweden was made conditional upon the nuclear industry’s ability to publicly demonstrate the possibility of achieving
‘absolute’ nuclear fuel safety. Due to the success of the KBS project in bringing controversy to an end, and in winning the stamp of government approval for successive versions of its KBS concept, the achievement of nuclear fuel safety in
Sweden has, for approaching 25 years now, centred on the stepwise implementation of the multi-barrier KBS-3 concept for the direct geological disposal of the nation’s spent nuclear fuel. While the KBS-3 concept can be seen as representing a long-run victory of nuclear waste technology over conflictual
nuclear politics in Sweden, this victory has remained incomplete so long as a site for a deep repository and the materialisation of the concept has remained undecided. Since 2002, the siting process has been re-centred on the KBS project’s two historically preferred sites where Sweden’s existing nuclear waste facilities are already clustered. As will be discussed in this paper, just when the KBS-3 concept appears close to fully materialising itself, it has run into yet another serious hurdle and an Environmental Impact Assessment process in respect of the Swedish Environmental Code – comprehensive environmental legislation introduced in 1999, more than 20 years after the KBS project was initiated. In facing this latest hurdle, it is becoming increasingly apparent that KBS-3, through the recent internationalisation of the Swedish nuclear industry, has outgrown its identity as a national solution to nuclear fuel safety, and is on the verge of mutating into a global platform in spent fuel/high-level waste management practice and technology.
Risk, Hazards and Crisis in Public Policy 1(4), Nov 2010
In this paper we critically evaluate contemporary processes of public involvement in nuclear acti... more In this paper we critically evaluate contemporary processes of public involvement in nuclear activities in Europe. Our focus is two collaborative “technology platforms” at the European level, one for implementing the geological disposal of nuclear waste, the other for rendering nuclear energy sustainable. In key documents and statements connected with the launching of these two platforms, public participation is assigned a vital role in their construction. While participation is presented in both cases as important for heightening the legitimacy of national nuclear industry programs and creating more room for public influence, the nature of this participation tends to remain obscure. From our analysis of the European Union documents and statements, informed by recent discussions in science and technology studies (STS), we conclude that “the participatory turn” in the nuclear sector focuses too strongly on procedural matters—on public involvement as a good in itself—while deflecting attention away from the possibilities of using participation as a more genuine means of enabling public issues and concerns to reach a higher level of articulation. Attempting to resolve legitimacy problems by conceiving of public participation as a way of maneuvering around public concerns is problematic since the latter must be more properly conceived as remaining the foundation for the former. If the issues calling for enlarged public participation in nuclear activities in Europe were awarded greater attention, then the legitimacy of these activities might indeed be improved. It can be imagined, for example, that the connections between the disposal of legacy wastes and the authorization of new build would be rendered more transparent.
As the distance between science and society is collapsed with the growth of contemporary knowledg... more As the distance between science and society is collapsed with the growth of contemporary knowledge societies, so a range of different approaches to the democratic governance of science superseding its Enlightenment government is emerging. In light of these different approaches, this article
focuses on the figure of the scientific citizen and the variable dimensions of a new scientific citizenship. Three models of democracy – advanced consumer, deliberative and radical/pluralist – are put forward as both partly
competing and partly complementary frameworks within which the new rights and responsibilities of the scientific citizen can be articulated and discussed. In each case the theory and practice of scientific citizenship are
viewed against the background of contemporary developments within the field of science communication; the rise of the public understanding of science movement; the new enthusiasm for advancing public engagements
with science, and the legitimate place of different forms of public protest and dissent within new designs for democratic governance.
Science popularisation is widely recognised as having its ‘political uses’ and as serving as a co... more Science popularisation is widely recognised as having its ‘political uses’ and as serving as a conventional means for buttressing the epistemic authority of the institutions of science in society. By separating the work of producing new knowledge from its dissemination, popularisation promotes public understanding and appreciation of science placed beyond public reach and influence. However, simply by insisting upon such a separation, so popularisation remains vulnerable to ‘capture’ by skilled and resourceful communicators intent on turning it against the established authority of scientists. This is a phenomenon which can be analysed in relation to the communicative strategies pursued by a collection of general practitioners, diabetics and self-styled dietary experts in Sweden championing a low-carbohydrate/high fat (LCHF) dietetics akin to the Diet Revolution initiated by Robert Atkins in the early 1970s. By dedicating themselves to achieving an overwhelming public presence in the propagation of simplified accounts of dietary science, the LCHF movement has been able to fashion science popularisation into a weapon capable of being turned back upon established dietary expertise in Sweden. In this effort they have proceeded on two fronts; firstly by debunking established dietary advice for failing to live up to idealised standards of ‘sound science’, and secondly, by effectively mobilising the personal testimony and endorsements of dieters themselves in order to publicly confirm the authenticity and trustworthiness of the LCHF regimen.
The new interest in staging public engagements with science, and the biosciences in particular, h... more The new interest in staging public engagements with science, and the biosciences in particular, has been widely associated with a 'democratic turn' in the public understanding of science movement. This article seeks to bring this association under closer scrutiny by focusing on the development of public engagement with biotechnology in Sweden. It analyses the production and dramatic composition of a two-part film documentary entitled Life at Stake, financed by the Swedish research community and broadcast on public service television. Particular attention is paid to the actions of the new non-profit organization Scientists Meet Film-Makers, and the crucial mediating role this organization played in creating the conditions of possibility for Life at Staketo be financed, produced and broadcast. In conclusion, rather than supporting a new logic of deliberation, Life at Stake is discussed as more concerned with symbolization and spectacle in its use of images of suffering and hope as the touchstone of truth about biotechnology in society. In this way, science communicators appear to be displaying a willingness to learn from the media practices of environmental organizations and other protest groups, who have long appreciated the importance of contesting symbolic codes and schemes of meaning in society.
Studies of digitally mediated learning, knowing, and expertise have been at the core of many rese... more Studies of digitally mediated learning, knowing, and expertise have been at the core of many research endeavors in recent years. Central to this effort are investigations focusing on gaining concrete insights into how the trans-disciplinary affordances of digital media are reconfiguring the established worlds of research, education, professional practice, and everyday life. While we generally seem to quite easily engage with and adapt to the media ecologies of our time, new digital tools and methods and the co-evolution of socio-cultural practices is also opening the way for new collaborative arrangements and cooperative efforts where, for example, patients become partners in their own care and treatment; ordinary citizens are mobilized in basic research; visitors participate in co-designing their museum experience; and students produce advanced visualizations of technoscientific controversies. In the face of such novel arrangements, researchers are increasingly being asked to both investigate and design new worlds of digital inquiry. So, while researchers are exploring how digital technologies are entangled in practices and processes of learning, their own methodological and analytical practices are being transformed by the very same digital innovations they are studying. One could say our research activities are contributing to envisioning and designing new worlds of experimentation and inquiry. This seminar accordingly aims to contribute to theoretical and methodological issues of studying and intervening in practices of learning and knowing in transformation. We seek to do this by drawing on generic or specific features of our trans-disciplinary studies of digital engagements across different kinds of practices and socio-technical configurations. The kind of studies we have in mind work in close collaboration with the people studied and their communities, i.e. projects are arranged through co-design. Or they reach across both disciplinary and professional boundaries and collaborate around the production as well as analysis of data. Relevant studies may also adopt the digital tools and methods they explore and incorporate them into their analytical approaches.
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Papers by Mark J Elam
BACKGROUND – This current of innovation, commencing already in the 1950s, carried the smokers’ clinic and nicotine replacement therapies (NRTs) into the world, both of which were originally invented and pioneered in Sweden. It
is argued that both of these inventions were vital for advancing the problematization of smoking as
a matter of nicotine addiction. While the British doctor Lennox Johnston is well-known for his early attempts to demonstrate the reality of smoking as nicotine addiction through auto-experimentation, the historical significance of Börje Ejrup’s founding of the first smokers’ clinics in Stockholm in the late 1950s has not been widely commented upon. Attempting to remedy this situation, the rise and fall of Ejrup’s clinics deploying lobeline substitution therapy as a cure for ‘nicotinism’ is outlined in the main body of the paper. FINDINGS – Although the clinical treatment of smoking as
addiction lost momentum during the 1960s, the invention of Nicorette gum in southern Sweden at the end of the decade provided renewed impetus. Commencing in Helsingborg and Lund in 1970, the smokers’ clinic and NRTs entered into the long-term service of each other; a new combination
that in just over a decade would succeed in propagating the reality of smoking as nicotine addiction
on to a global stage.
Approach – Through historical analysis it is discussed how cigarette smoking only became widely accepted as a real drug problem in the 1980s after it had been shown to be amenable to treatment as such through the use of novel nicotine replacement therapies.
Findings – These replacement therapies succeeded in showing that the same drug that drew users into addiction could be redeployed to help draw up them out of it. Nicorette® could serve as at least the partial antidote to nico-wrong (cigarettes). However, as relapse to smoking has remained the most likely outcome of any smoking cessation attempt, so medicinal nicotine has also served to demonstrate that nicotine addiction is ultimately a problem of an uncontrollable appetite for cigarettes in excess of drug dependence.
Implications – Pharmaceutical incursion on cigarette smoking commencing in the late 1970s pointed to the need for a new mental disease model of drug-related problems while also providing valuable new tools and insights for ensuing brain research.
closer to a long-term solution of the nuclear waste problem, but by upholding and developing its capacity to demonstrate that such a solution remains within sight and practical reach.
project was born under extraordinary circumstances during the 1970s when the future of nuclear power generation in Sweden was made conditional upon the nuclear industry’s ability to publicly demonstrate the possibility of achieving
‘absolute’ nuclear fuel safety. Due to the success of the KBS project in bringing controversy to an end, and in winning the stamp of government approval for successive versions of its KBS concept, the achievement of nuclear fuel safety in
Sweden has, for approaching 25 years now, centred on the stepwise implementation of the multi-barrier KBS-3 concept for the direct geological disposal of the nation’s spent nuclear fuel. While the KBS-3 concept can be seen as representing a long-run victory of nuclear waste technology over conflictual
nuclear politics in Sweden, this victory has remained incomplete so long as a site for a deep repository and the materialisation of the concept has remained undecided. Since 2002, the siting process has been re-centred on the KBS project’s two historically preferred sites where Sweden’s existing nuclear waste facilities are already clustered. As will be discussed in this paper, just when the KBS-3 concept appears close to fully materialising itself, it has run into yet another serious hurdle and an Environmental Impact Assessment process in respect of the Swedish Environmental Code – comprehensive environmental legislation introduced in 1999, more than 20 years after the KBS project was initiated. In facing this latest hurdle, it is becoming increasingly apparent that KBS-3, through the recent internationalisation of the Swedish nuclear industry, has outgrown its identity as a national solution to nuclear fuel safety, and is on the verge of mutating into a global platform in spent fuel/high-level waste management practice and technology.
focuses on the figure of the scientific citizen and the variable dimensions of a new scientific citizenship. Three models of democracy – advanced consumer, deliberative and radical/pluralist – are put forward as both partly
competing and partly complementary frameworks within which the new rights and responsibilities of the scientific citizen can be articulated and discussed. In each case the theory and practice of scientific citizenship are
viewed against the background of contemporary developments within the field of science communication; the rise of the public understanding of science movement; the new enthusiasm for advancing public engagements
with science, and the legitimate place of different forms of public protest and dissent within new designs for democratic governance.
Seminars Organized by Mark J Elam
BACKGROUND – This current of innovation, commencing already in the 1950s, carried the smokers’ clinic and nicotine replacement therapies (NRTs) into the world, both of which were originally invented and pioneered in Sweden. It
is argued that both of these inventions were vital for advancing the problematization of smoking as
a matter of nicotine addiction. While the British doctor Lennox Johnston is well-known for his early attempts to demonstrate the reality of smoking as nicotine addiction through auto-experimentation, the historical significance of Börje Ejrup’s founding of the first smokers’ clinics in Stockholm in the late 1950s has not been widely commented upon. Attempting to remedy this situation, the rise and fall of Ejrup’s clinics deploying lobeline substitution therapy as a cure for ‘nicotinism’ is outlined in the main body of the paper. FINDINGS – Although the clinical treatment of smoking as
addiction lost momentum during the 1960s, the invention of Nicorette gum in southern Sweden at the end of the decade provided renewed impetus. Commencing in Helsingborg and Lund in 1970, the smokers’ clinic and NRTs entered into the long-term service of each other; a new combination
that in just over a decade would succeed in propagating the reality of smoking as nicotine addiction
on to a global stage.
Approach – Through historical analysis it is discussed how cigarette smoking only became widely accepted as a real drug problem in the 1980s after it had been shown to be amenable to treatment as such through the use of novel nicotine replacement therapies.
Findings – These replacement therapies succeeded in showing that the same drug that drew users into addiction could be redeployed to help draw up them out of it. Nicorette® could serve as at least the partial antidote to nico-wrong (cigarettes). However, as relapse to smoking has remained the most likely outcome of any smoking cessation attempt, so medicinal nicotine has also served to demonstrate that nicotine addiction is ultimately a problem of an uncontrollable appetite for cigarettes in excess of drug dependence.
Implications – Pharmaceutical incursion on cigarette smoking commencing in the late 1970s pointed to the need for a new mental disease model of drug-related problems while also providing valuable new tools and insights for ensuing brain research.
closer to a long-term solution of the nuclear waste problem, but by upholding and developing its capacity to demonstrate that such a solution remains within sight and practical reach.
project was born under extraordinary circumstances during the 1970s when the future of nuclear power generation in Sweden was made conditional upon the nuclear industry’s ability to publicly demonstrate the possibility of achieving
‘absolute’ nuclear fuel safety. Due to the success of the KBS project in bringing controversy to an end, and in winning the stamp of government approval for successive versions of its KBS concept, the achievement of nuclear fuel safety in
Sweden has, for approaching 25 years now, centred on the stepwise implementation of the multi-barrier KBS-3 concept for the direct geological disposal of the nation’s spent nuclear fuel. While the KBS-3 concept can be seen as representing a long-run victory of nuclear waste technology over conflictual
nuclear politics in Sweden, this victory has remained incomplete so long as a site for a deep repository and the materialisation of the concept has remained undecided. Since 2002, the siting process has been re-centred on the KBS project’s two historically preferred sites where Sweden’s existing nuclear waste facilities are already clustered. As will be discussed in this paper, just when the KBS-3 concept appears close to fully materialising itself, it has run into yet another serious hurdle and an Environmental Impact Assessment process in respect of the Swedish Environmental Code – comprehensive environmental legislation introduced in 1999, more than 20 years after the KBS project was initiated. In facing this latest hurdle, it is becoming increasingly apparent that KBS-3, through the recent internationalisation of the Swedish nuclear industry, has outgrown its identity as a national solution to nuclear fuel safety, and is on the verge of mutating into a global platform in spent fuel/high-level waste management practice and technology.
focuses on the figure of the scientific citizen and the variable dimensions of a new scientific citizenship. Three models of democracy – advanced consumer, deliberative and radical/pluralist – are put forward as both partly
competing and partly complementary frameworks within which the new rights and responsibilities of the scientific citizen can be articulated and discussed. In each case the theory and practice of scientific citizenship are
viewed against the background of contemporary developments within the field of science communication; the rise of the public understanding of science movement; the new enthusiasm for advancing public engagements
with science, and the legitimate place of different forms of public protest and dissent within new designs for democratic governance.