Bringing the Global into Medical Sociology: Medicalization, Narrative, and Global Health.

Medical sociologists have much to gain by bringing in global health. In this article, I make the case for expanding our field by furthering sociological perspectives on global health. I reflect on my career, the influence of scholar-activist mentors, and my contributions to the development of scholarship about medicalization, narrative, and global health in medical sociology. First, I focus on medicalization, its relationship to biomedicalization and pharmaceuticalization, and critiques of the medicalization of global health. Second, I analyze the narrative turn in studies of illness experiences and the inclusion of visual materials as an integral part of narrative studies of illness. Third, I explore global health and show examples of bodies of knowledge that medical sociologists are building. Although I present each as a distinct area, my discussion illustrates how the three areas are intertwined and how my contributions to each traverse and build connections among them.

Symposium: Risk, innovation and ignorance production in the field of reproductive biomedicine.

This commentary evaluates the contributions to this special issue through a feminist lens. It reviews the field of ignorance studies and two distinguishable areas in the field: undone science and ignorance/non-knowledge. It points to ways in which the articles in this special issue engage with the social production of ignorance. It explores feminist roots of ignorance studies, including feminist ignorance epistemologies, identifies strengths and gaps in ignorance studies, and suggests possible lines of future work.

The case for refugee physicians: Forced migration of International Medical Graduates in the 21st century.

In this paper we propose a new category of International Medical Graduates (IMGs) who are forced to leave their home countries: "refugee physicians." In US social science scholarship, IMGs are divided into US citizen IMG (USIMG) and non-US citizen IMG (non-USIMG). For purposes of US medical licensure qualifications and recordkeeping, US- and non-USIMGs are lumped together. These categorizations are too blunt to demonstrate important differences among non-USIMGs. The category of "refugee physicians" distinguishes non-USIMGs who are forced to flee their homelands from other IMGs. We define and develop this category based on qualitative in-depth interviews conducted in 2019 with 28 non-USIMGs who fled to the US within the past 15 years. Using narrative analysis, we constructed "flight biographies," storied chronological events and experiences, for each physician. The flight biographies highlight the medical and political contexts in which they were forced to flee and are situated in the US. Two representative cases demonstrate how and why lumping refugee physicians together with other IMGs obscures the constraints and challenges that set them apart from the other IMG categories. First, the term refugee physician focuses attention on how physicians are located among forcibly displaced people worldwide, including their distinct relationships to their home countries, transit countries in which some of them seek sanctuary, and the US, where some requested asylum and others have been resettled. Second, because refugee is an umbrella term that blends categories of law, policy, social science, and everyday usage it encompasses a wide variety of lived experiences along a continuum of compulsion to leave. Finally, refugee physician illuminates the group's distinct relationship to medical licensure and brings into focus structural barriers that impede their goal of gaining a US medical license.

Interpreter assemblages: Caring for immigrant and refugee patients in US hospitals.

US hospitals have developed a variety of strategies to meet federal requirements and provide culturally and linguistically appropriate health care for people who report limited English proficiency. A key strategy is the use of healthcare interpreters who may be physically present in the room or in the room via telephone or video conference. This paper analyzes the contingent and unstable combinations of heterogeneous human and nonhuman elements that form and disperse during visits to the hospital when healthcare interpreters are used. It draws its analysis from 9 months of fieldwork in 2012 that included following 69 adult immigrant and refugee patients in one hospital in Maine and observing encounters with interpreters and clinic staff. It introduces the concept of interpreter assemblage to make sense of the transnational mixes of people, technologies, and ideas that bring multilingual hospital care to life and give it a character of its own.

Placing care: embodying architecture in hospital clinics for immigrant and refugee patients.

This article is part of a hospital ethnography that investigates healthcare architecture as an aspect of an increasingly large, complex, and urgent global health issue: caring for refugees and other immigrants. It argues that hospitals are nodes in transnational social networks of immigrant and refugee patients that form assemblages of human and non-human objects. These assemblages co-produce place-specific hospital care in different hospital spaces. Place-specific tensions and power dynamics arise when refugees and immigrants come into contact with these biomedical spaces. The argument is developed by analysing waiting rooms and exam rooms in two outpatient clinics in one US hospital. The article draws its analysis from 9 months of fieldwork in 2012 that included following 69 adult immigrant and refugee patients and observing their encounters with interpreters and clinic staff. Its inclusion of a transnational dimension for understanding place-specific hospital care adds conceptual and empirical depth to the study of how place matters in 21st century hospitals.

Long-term follow-up of MRC Myeloma IX trial: Survival outcomes with bisphosphonate and thalidomide treatment.

PURPOSE: Medical Research Council (MRC) Myeloma IX was a phase III trial evaluating bisphosphonate and thalidomide-based therapy for newly diagnosed multiple myeloma. Results were reported previously after a median follow-up of 3.7 years (current controlled trials number: ISRCTN68454111). Survival outcomes were reanalyzed after an extended follow-up (median, 5.9 years). EXPERIMENTAL DESIGN: At first randomization, patients (N = 1,970) were assigned to bisphosphonate (clodronic acid or zoledronic acid) and induction therapies [cyclophosphamide-vincristine-doxorubicin-dexamethasone (CVAD) or cyclophosphamide-thalidomide-dexamethasone (CTD) followed by high-dose therapy plus autologous stem cell transplantation for younger/fitter patients (intensive pathway), and melphalan-prednisone (MP) or attenuated CTD (CTDa) for older/less fit patients (nonintensive pathway)]. At second randomization, patients were assigned to thalidomide maintenance therapy or no maintenance. Interphase FISH (iFISH) was used to analyze cytogenics. RESULTS: Zoledronic acid significantly improved progression-free survival (PFS; HR, 0.89; P = 0.02) and overall survival (OS; HR, 0.86; P = 0.01) compared with clodronic acid. In the intensive pathway, CTD showed noninferior PFS and OS compared with CVAD, with a trend toward improved OS in patients with favorable cytogenics (P = 0.068). In the nonintensive pathway, CTDa significantly improved PFS (HR, 0.81; P = 0.007) compared with MP and there was an emergent survival benefit after 18 to 24 months. Thalidomide maintenance improved PFS (HR, 1.44; P < 0.0001) but not OS (HR, 0.96; P = 0.70), and was associated with shorter OS in patients with adverse cytogenics (P = 0.01). CONCLUSIONS: Long-term follow-up is essential to identify clinically meaningful treatment effects in myeloma subgroups based on cytogenetics.

Medicalization and pharmaceuticalization at the intersections: Looking backward, sideways and forward.

Medicalization studies have changed dramatically in the past decade in part due to the increased attention to the role of pharmaceuticals and the pharmaceutical industry in modern life. This review paper explores the relationship between the concepts of medicalization and the newly developed terms of pharmaceuticalization and the pharmaceuticalization of public health. We show how and why modernist thinking limits the terms' utility to explain a world in which both modern and postmodern objects and people interact with each other. We provide a framework for reconceptualizing and empirically studying these key processes of the 21st century.

Claiming justice: knowing mental illness in the public art of Anna Schuleit's 'Habeas Corpus' and 'Bloom'.

This study investigates two public art performances by artist Anna Schuleit in the early 2000s commemorating the life and history of two state hospitals ('asylums') in Massachusetts and the people who built, worked, and were patients in them. Public art is made for and sited in the public domain, outside, freely accessible, frequently collaborative, and often ephemeral. This study addresses a series of questions: What can public art 'do' for understanding mental illness? What use is a public art project for those living with (and caring for those who live with) mental illness? How can a public work of art sustain and portray meaning in an expressive way, open up a shared discursive space, and demand witness through embodiment?

Artworks, collective experience and claims for social justice: the case of women living with breast cancer.

This article discusses the role of 'artworks' produced by women with breast cancer in the context of breast cancer activism. We argue that such works play a key role in making visible and collective the ideological issues surrounding this disease. They do this through their potential for anchoring social practices relating to its treatment and what might be done about it (Klawiter 2004, Swidler 2001). The article focuses upon the work of two women artists diagnosed with breast cancer--the British photographer Jo Spence, and Martha Hall, an American who made artist's books. We examine specific works from these collections, and the context of their production. In this way we show how and why artworks are important in establishing visual and discursive space related to social practices associated with disease regimes, and how they provide emancipatory potential for women living with breast cancer. We argue that artworks work through and on bodies to enable a redemptive and emancipatory potential. As mediators of representations of illness, they deserve attention from sociologists researching social movements, the sharing of illness experience and strategies for survival.

High-dose chemotherapy with hematopoietic stem-cell rescue for multiple myeloma.

BACKGROUND: High-dose therapy with supporting autologous stem-cell transplantation remains a controversial treatment for cancer. In multiple myeloma, first-line regimens incorporating high-dose therapy yield higher remission rates than do conventional-dose treatments, but evidence that this translates into improved survival is limited. METHODS: In this multicenter study, the Medical Research Council Myeloma VII Trial, we randomly assigned 407 patients with previously untreated multiple myeloma who were younger than 65 years of age to receive either standard conventional-dose combination chemotherapy or high-dose therapy and an autologous stem-cell transplant. RESULTS: Among the 401 patients who could be evaluated, the rates of complete response were higher in the intensive-therapy group than in the standard-therapy group (44 percent vs. 8 percent, P<0.001). The rates of partial response were similar (42 percent and 40 percent, respectively; P=0.72), and the rates of minimal response were lower in the intensive-therapy group than in the standard-therapy group (3 percent vs. 18 percent, P<0.001). Intention-to-treat analysis showed a higher rate of overall survival (P=0.04 by the log-rank test) and progression-free survival (P<0.001) in the intensive-therapy group than in the standard-therapy group. As compared with standard therapy, intensive treatment increased median survival by almost 1 year (54.1 months [95 percent confidence interval, 44.9 to 65.2] vs. 42.3 months [95 percent confidence interval, 33.1 to 51.6]). There was a trend toward a greater survival benefit in the group of patients with a poor prognosis, as defined by a high beta2-microglobulin level (more than 8 mg per liter). CONCLUSIONS: High-dose therapy with autologous stem-cell rescue is an effective first-line treatment for patients with multiple myeloma who are younger than 65 years of age.