Medicalization is frequently defined as a process by which some non-medical aspects of human life become to be considered as medical problems. Overdiagnosis, on the other hand, is most often defined as diagnosing a biomedical condition that in the absence of testing would not cause symptoms or death in the person’s lifetime. Medicalization and overdiagnosis are related concepts as both expand the extension of the concept of disease. They are both often used normatively to critique unwarranted or contested expansion of (...) medicine and to address health services that are considered to be unnecessary, futile, or even harmful. However, there are important differences between the concepts, as not all cases of overdiagnosis are medicalizations and not all cases of medicalizations are overdiagnosis. The objective of this article is to clarify the differences between medicalization and overdiagnosis. It will demonstrate how the subject matter of medicalization traditionally has been non-medical (social or cultural everyday life) phenomena, while the subject matter of overdiagnosis has been biological or biomolecular conditions or processes acknowledged being potentially harmful. They also refer to different types of uncertainty: medicalization is concerned with indeterminacy, while overdiagnosis is concerned with lack of prognostic knowledge. Medicalization is dealing with sickness (sick role) while overdiagnosis with disease. Despite these differences, medicalization and overdiagnosis are becoming more alike. Medicalization is expanding, encompassing the more “technical” aspects of overdiagnosis, while overdiagnosis is becoming more ideologized. Moreover, with new trends in modern medicine, such as P4 (preventive, predictive, personal, and participatory) medicine, medicalization will become all-encompassing, while overdiagnosis more or less may dissolve. In the end they may converge in some total “iatrogenization.” In doing so, the concepts may lose their precision and critical sting. (shrink)

Precision Medicine has become a common label for data-intensive and patient-driven biomedical research. Its intended future is reflected in endeavours such as the Precision Medicine Initiative in the USA. This article addresses the question whether it is possible to discern a new ‘medical cosmology’ in Precision Medicine, a concept that was developed by Nicholas Jewson to describe comprehensive transformations involving various dimensions of biomedical knowledge and practice, such as vocabularies, the roles of patients and physicians and the conceptualisation of disease. (...) Subsequently, I will elaborate my assessment of the features of Precision Medicine with the help of Michel Foucault, by exploring how precision medicine involves a transformation along three axes: the axis of biomedical knowledge, of biomedical power and of the patient as a self. Patients are encouraged to become the managers of their own health status, while the medical domain is reframed as a data-sharing community, characterised by changing power relationships between providers and patients, producers and consumers. While the emerging Precision Medicine cosmology may surpass existing knowledge frameworks; it obscures previous traditions and reduces research-subjects to mere data. This in turn, means that the individual is both subjected to the neoliberal demand to share personal information, and at the same time has acquired the positive ‘right’ to become a member of the data-sharing community. The subject has to constantly negotiate the meaning of his or her data, which can either enable self-expression, or function as a commanding Superego. (shrink)

The promises of nanotechnology have been framed by a variety of metaphors, that not only channel the attention of the public, orient the questions asked by researchers, and convey epistemic choices closely linked to ethical preferences. In particular, the image of the ‘therapeutic missile’ commonly used to present targeted drug delivery devices emphasizes precision, control, surveillance and efficiency. Such values are highly praised in the current context of crisis of pharmaceutical innovation where military metaphors foster a general mobilization of resources (...) from multiple fields of cutting-edge research. The missile metaphor, reminiscent of Paul Ehrlich’s ‘magic bullet’, has framed the problem in simple terms: how to deliver the right dose in the right place at the right moment? Chemists, physicists and engineers who design multi-functional devices operating in vitro can think in such terms, as long as the devices are not actually operating through the messy environment of the body. A close look at what has been done and what remains to be done suggests that the metaphor of the “therapeutic missile” is neither sufficient, nor even necessary. Recent developments in nanomedicine suggest that therapeutic efficacy cannot be obtained without negotiating with the biological milieu and taking advantage of what it affords. An ‘oikological’ approach seems more appropriate, more heuristic and more promising than the popular missile. It is based on the view of organism as an oikos that has to be carefully managed. The dispositions of nanocapsules have to be coupled with the affordances of the environment. As it requires dealing with nanoparticles as relational entities (defined by their potential for interactions) rather than as stable substances (defined by intrinsic properties) this metaphor eventually might well change research priorities in nanotechnology in general. (shrink)

There are two primary camps in which nanotechnology today can be categorized normal nanotechnology and speculative nanotechnology. The birth of nanotechnology proper was conceived through discourses of speculative nanotechnology. However, current nanotech-nology research has detracted from its speculative promises in favour of more attainable material products. Nonetheless, normal nanotechnology has leveraged the popular support and consequential funding it needs to conduct research and development (R&D) as a result of popular conceptions of speculative nanotechnology and its promises. Similarly, the scholarly literature (...) has shifted its focus away from speculative nanofutures towards normal nanotech-nology R&D. This paper shows that there is an incongruence between the representation of nanotechnology in the media, scholarly journals and industry. (shrink)

The emergence of nanotechnology, with all its promises of economic, social, and medical benefits, along with dire predictions of environmental, health, and safety threats, has occasioned an active debate in the Science and Technology Studies field, in which we have seen five distinct conversations that frame the discussion. The topical threads include ethics, regulation, opportunities and threats including utopian/dystopian visions of the future, public perception, public participation. These conversational distinctions are not absolutes with firm borders as they clearly overlap at (...) many points. Nonetheless, common to all is a strong sense that control and consequence are significant problems that have yet to be addressed adequately by the promoters of nanotechnology. A final section addresses articles on nanotechnology that exemplify the social construction theory of technology. We include herein a selective summary of this recent body of science, technology, and society (STS) journal literature focused on the social and ethical interactions of nanotechnology (SEIN) that has emerged in the last few years. The intent is not to be encyclopedic in coverage, but rather to seek to understand, in a general way, the key issues and concepts STS scholars are discussing. It is clear that STS-oriented scholars are well poised to grapple explicitly with the cultural, socio-political, and ethical dimensions of nanotechnology. Drawing on understandings of earlier socio-technical areas of interest and concern—nuclear power, genetically modified organisms, the human genome—such scholars have moved well beyond the questions of whether and where nanotechnology intersects society. More important is their effort to seek an understanding in depth of exactly how they are socio-politically, culturally, and ethically interconnected. In doing so, SEIN studies have at the same time become increasingly diverse and more sophisticated and mature over the course of the past decade. Scholars have quite rightly recognized the inadequacies of blanket ideas of moratoria versus non-regulatory environments, utopian versus dystopian futures, and whether or not the public has a role to play in nanotechnology decision making. Rather, a more sophisticated, often case specific, flexible understanding of the societal context of a given issue or concern is called for. (shrink)