This paper addresses debates concerning the ‘participatory turn’ in healthcare. It focuses on the... more This paper addresses debates concerning the ‘participatory turn’ in healthcare. It focuses on the case of blood pressure self-monitoring, understanding this as a form of patient participation at the level of individual care. Drawing and expanding on the work of Marres and Wynne and their notions of material participation and of uninvited engagement, we examine how patients’ home blood pressure self-monitoring is incorporated into clinical care, how the materials of blood pressure self-monitoring mediate participation and how we might characterise the practices of participation found within everyday clinical care. Our analysis makes new conceptual links, suggesting that, in this context, invited participation appears to align with participation made easy, while uninvited participation involves more invested, more engaged participation. We offer two further developments of these concepts. First, we trouble characterisations of invited and uninvited participation as distinct and sep...
BackgroundHome self-monitoring of blood pressure is widely used in primary care to assist in the ... more BackgroundHome self-monitoring of blood pressure is widely used in primary care to assist in the diagnosis of hypertension, as well as to improve clinical outcomes and support adherence to medication. The National Institute for Health and Care Excellence (NICE) care pathways for hypertension recommend specific guidelines, although they lack detail on supporting patients to self-monitor.AimTo elicit primary care practitioners’ experiences of managing patients’ home blood pressure self-monitoring, across surgeries located in different socioeconomic areas.Design & settingA qualitative focus group study was conducted with a total of 21 primary care professionals.MethodParticipants were GPs and practice nurses (PNs), purposively recruited from surgeries in areas of low and high deprivation, according to the English indices of multiple deprivation. Six vignettes were developed featuring data from interviews with people who self-monitor and these were used in five focus groups. Results wer...
In this paper we explore the field of allergy as it appears on the Internet. Starting from a simp... more In this paper we explore the field of allergy as it appears on the Internet. Starting from a simple search, we draw attention to the ways in which allergy is created as both clinical condition and series of market opportunities. Where medical sociology has often been critical of commercial, especially pharmaceutical, involvement in health, and tended to celebrate the activities of patient organisations, we use discourse analysis to examine the similar strategies and messages from commercial and voluntary actors, and the ways in which sufferers are encouraged both to defer to medical expertise and also to take responsibility for finding their own ways to live with allergy in daily life. We suggest this creates difficulties for readers who are positioned as both patients and consumers through more or less awkward juxtapositions of advice and product placement in health markets that go well beyond pharmaceuticals, and suggest that these markets deserve more attention from medical socio...
This paper considers the uses and non-uses of a particular class of pharmaceutical - statins - dr... more This paper considers the uses and non-uses of a particular class of pharmaceutical - statins - drawing on UK fieldwork. These drugs to lower cholesterol have become widely available on prescription, but may not be accepted by patients. In medical sociology the non-use of medicines has been described through the lens of ‘resistance’, as a counter to medical concerns with adherence, yet these discussions have not referred to STS ideas about the uses and non-uses of technologies. We examine points of articulation and difference between these frameworks. In particular we consider the value of Wyatt’s (2003) taxonomy of non-users for our case. Our analysis draws attention to the potential transience of use and non-use over time and the social relations through which this might be mediated. In doing this, we suggest an analytical shift from the identity of actors as users or non-users to the practices of use and non-use.
The book relates to a seminar series ‘New Practices for NewPublics', which ran between Novemb... more The book relates to a seminar series ‘New Practices for NewPublics', which ran between November 2015 and October 2017 (see http://blogs.brighton.ac.uk/newpracticesfornewpublics/). Both the book and the seminars were funded by grant ES/N009398/1 from the Economic and Social Research Council.
This paper considers the uses and non-uses of a particular class of pharmaceutical - statins - dr... more This paper considers the uses and non-uses of a particular class of pharmaceutical - statins - drawing on UK fieldwork. These drugs to lower cholesterol have become widely available on prescription, but may not be accepted by patients. In medical sociology the non-use of medicines has been described through the lens of ‘resistance’, as a counter to medical concerns with adherence, yet these discussions have not referred to STS ideas about the uses and non-uses of technologies. We examine points of articulation and difference between these frameworks. In particular we consider the value of Wyatt’s (2003) taxonomy of non-users for our case. Our analysis draws attention to the potential transience of use and non-use over time and the social relations through which this might be mediated. In doing this, we suggest an analytical shift from the identity of actors as users or non-users to the practices of use and non-use.
Without microbes, no other forms of life would be possible. But what does it mean to be with micr... more Without microbes, no other forms of life would be possible. But what does it mean to be with microbes? In this book, 24 contributors attune to microbes and describe their multiple relationships with humans and others. Ethnographic explorations with fermented foods, waste, faecal matter, immunity, antimicrobial resistance, phages, as well as indigenous and scientific understandings of microbes challenge ideas of them being simple entities: not just pathogenic foes, old friends or good fermentation minions, but much more. Following various entanglements, the book tells how these relations transform both humans and microbes in the process.
Previous scholarship on novel foods, including functional foods, has suggested that they are diff... more Previous scholarship on novel foods, including functional foods, has suggested that they are difficult to categorise for both regulators and users. It is argued that they blur the boundary between 'food' and 'drug' and that uncertainties about the products create 'experimental' or 'restless' approaches to consumption. We investigate these uncertainties drawing on data about the use of functional foods containing phytosterols, which are licensed for sale in the EU for people wishing to reduce their cholesterol. We start from an interest in the products as material objects and their incorporation into everyday practices. We consider the scripts encoded in the physical form of the products through their regulation, production and packaging and find that these scripts shape but do not determine their use. The domestication of phytosterols involves bundling the products together with other objects (pills, supplements, foodstuffs). Considering their incorpo...
This paper offers a critical reflection on changes in cardiac surgical research based on empirica... more This paper offers a critical reflection on changes in cardiac surgical research based on empirical work on the development of implantable circulatory support devices over appropriately 20 years to the present. Trials of surgery and implantable devices have received relatively little attention from social science, but offer important comparisons with the pharmacological and organisational trials examined in the literature and in our own previous work. Drawing on journal commentary, trial reports, and policy documents, we focus on the emergence of more adaptive trial designs and the use of registries in the assessment of devices. These very different developments can be viewed as social experiments, shaping new relationships between physicians, manufacturers and regulators (or private and public actors) as well as more or less formal statements about what should count as evidence in the device field. Yet while such agreements increasingly included a public account of the ongoing and improvisational quality of surgical innovation around devices (allowing for patient populations, endpoints or devices themselves to be modified in a single study), they also obscured or bracketed other adaptations which remained informal and private (including changing methods of implantation and the space allowed for surgeons’ developing skills and preferences), which we describe with reference to ethnographic data on our case. We conclude with a reflection on the contemporary reach and meaning of the RCT as the dominant mode of knowledge production in medicine.
This paper addresses debates concerning the ‘participatory turn’ in healthcare. It focuses on the... more This paper addresses debates concerning the ‘participatory turn’ in healthcare. It focuses on the case of blood pressure self-monitoring, understanding this as a form of patient participation at the level of individual care. Drawing and expanding on the work of Marres and Wynne and their notions of material participation and of uninvited engagement, we examine how patients’ home blood pressure self-monitoring is incorporated into clinical care, how the materials of blood pressure self-monitoring mediate participation and how we might characterise the practices of participation found within everyday clinical care. Our analysis makes new conceptual links, suggesting that, in this context, invited participation appears to align with participation made easy, while uninvited participation involves more invested, more engaged participation. We offer two further developments of these concepts. First, we trouble characterisations of invited and uninvited participation as distinct and sep...
BackgroundHome self-monitoring of blood pressure is widely used in primary care to assist in the ... more BackgroundHome self-monitoring of blood pressure is widely used in primary care to assist in the diagnosis of hypertension, as well as to improve clinical outcomes and support adherence to medication. The National Institute for Health and Care Excellence (NICE) care pathways for hypertension recommend specific guidelines, although they lack detail on supporting patients to self-monitor.AimTo elicit primary care practitioners’ experiences of managing patients’ home blood pressure self-monitoring, across surgeries located in different socioeconomic areas.Design & settingA qualitative focus group study was conducted with a total of 21 primary care professionals.MethodParticipants were GPs and practice nurses (PNs), purposively recruited from surgeries in areas of low and high deprivation, according to the English indices of multiple deprivation. Six vignettes were developed featuring data from interviews with people who self-monitor and these were used in five focus groups. Results wer...
In this paper we explore the field of allergy as it appears on the Internet. Starting from a simp... more In this paper we explore the field of allergy as it appears on the Internet. Starting from a simple search, we draw attention to the ways in which allergy is created as both clinical condition and series of market opportunities. Where medical sociology has often been critical of commercial, especially pharmaceutical, involvement in health, and tended to celebrate the activities of patient organisations, we use discourse analysis to examine the similar strategies and messages from commercial and voluntary actors, and the ways in which sufferers are encouraged both to defer to medical expertise and also to take responsibility for finding their own ways to live with allergy in daily life. We suggest this creates difficulties for readers who are positioned as both patients and consumers through more or less awkward juxtapositions of advice and product placement in health markets that go well beyond pharmaceuticals, and suggest that these markets deserve more attention from medical socio...
This paper considers the uses and non-uses of a particular class of pharmaceutical - statins - dr... more This paper considers the uses and non-uses of a particular class of pharmaceutical - statins - drawing on UK fieldwork. These drugs to lower cholesterol have become widely available on prescription, but may not be accepted by patients. In medical sociology the non-use of medicines has been described through the lens of ‘resistance’, as a counter to medical concerns with adherence, yet these discussions have not referred to STS ideas about the uses and non-uses of technologies. We examine points of articulation and difference between these frameworks. In particular we consider the value of Wyatt’s (2003) taxonomy of non-users for our case. Our analysis draws attention to the potential transience of use and non-use over time and the social relations through which this might be mediated. In doing this, we suggest an analytical shift from the identity of actors as users or non-users to the practices of use and non-use.
The book relates to a seminar series ‘New Practices for NewPublics', which ran between Novemb... more The book relates to a seminar series ‘New Practices for NewPublics', which ran between November 2015 and October 2017 (see http://blogs.brighton.ac.uk/newpracticesfornewpublics/). Both the book and the seminars were funded by grant ES/N009398/1 from the Economic and Social Research Council.
This paper considers the uses and non-uses of a particular class of pharmaceutical - statins - dr... more This paper considers the uses and non-uses of a particular class of pharmaceutical - statins - drawing on UK fieldwork. These drugs to lower cholesterol have become widely available on prescription, but may not be accepted by patients. In medical sociology the non-use of medicines has been described through the lens of ‘resistance’, as a counter to medical concerns with adherence, yet these discussions have not referred to STS ideas about the uses and non-uses of technologies. We examine points of articulation and difference between these frameworks. In particular we consider the value of Wyatt’s (2003) taxonomy of non-users for our case. Our analysis draws attention to the potential transience of use and non-use over time and the social relations through which this might be mediated. In doing this, we suggest an analytical shift from the identity of actors as users or non-users to the practices of use and non-use.
Without microbes, no other forms of life would be possible. But what does it mean to be with micr... more Without microbes, no other forms of life would be possible. But what does it mean to be with microbes? In this book, 24 contributors attune to microbes and describe their multiple relationships with humans and others. Ethnographic explorations with fermented foods, waste, faecal matter, immunity, antimicrobial resistance, phages, as well as indigenous and scientific understandings of microbes challenge ideas of them being simple entities: not just pathogenic foes, old friends or good fermentation minions, but much more. Following various entanglements, the book tells how these relations transform both humans and microbes in the process.
Previous scholarship on novel foods, including functional foods, has suggested that they are diff... more Previous scholarship on novel foods, including functional foods, has suggested that they are difficult to categorise for both regulators and users. It is argued that they blur the boundary between 'food' and 'drug' and that uncertainties about the products create 'experimental' or 'restless' approaches to consumption. We investigate these uncertainties drawing on data about the use of functional foods containing phytosterols, which are licensed for sale in the EU for people wishing to reduce their cholesterol. We start from an interest in the products as material objects and their incorporation into everyday practices. We consider the scripts encoded in the physical form of the products through their regulation, production and packaging and find that these scripts shape but do not determine their use. The domestication of phytosterols involves bundling the products together with other objects (pills, supplements, foodstuffs). Considering their incorpo...
This paper offers a critical reflection on changes in cardiac surgical research based on empirica... more This paper offers a critical reflection on changes in cardiac surgical research based on empirical work on the development of implantable circulatory support devices over appropriately 20 years to the present. Trials of surgery and implantable devices have received relatively little attention from social science, but offer important comparisons with the pharmacological and organisational trials examined in the literature and in our own previous work. Drawing on journal commentary, trial reports, and policy documents, we focus on the emergence of more adaptive trial designs and the use of registries in the assessment of devices. These very different developments can be viewed as social experiments, shaping new relationships between physicians, manufacturers and regulators (or private and public actors) as well as more or less formal statements about what should count as evidence in the device field. Yet while such agreements increasingly included a public account of the ongoing and improvisational quality of surgical innovation around devices (allowing for patient populations, endpoints or devices themselves to be modified in a single study), they also obscured or bracketed other adaptations which remained informal and private (including changing methods of implantation and the space allowed for surgeons’ developing skills and preferences), which we describe with reference to ethnographic data on our case. We conclude with a reflection on the contemporary reach and meaning of the RCT as the dominant mode of knowledge production in medicine.
Clinical trials have become key technologies for decision making in the contemporary world. Their... more Clinical trials have become key technologies for decision making in the contemporary world. Their results shape medical practice and determine priorities across health care systems, but the work that goes into producing credible data is often hidden. Medical Proofs, Social Experiments draws upon detailed case studies to argue that to understand their value, we need to pay more attention to the contexts for these modern medical experiments, recovering the diverse ways in which they involve doctors, patients and the public, the local practices that contribute to their completion, and the complex negotiation of their results in professional and statutory institutions. Presenting research from the UK, USA, Sweden and The Netherlands, the ethnographic perspective adopted by the authors provides a space to explore the investments of different state, market, professional and other actors in particular forms of evaluation, and the ways in which trial methodologies may be re-designed or re-imagined to satisfy social and political expectations. As such, this volume will be of interest to those working in the fields of science and technology studies, the sociology and anthropology of medicine and researchers of policy and organisation in health care.
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Papers by Catherine Will