This paper focuses on Precision Public Health (PPH), described in the scientific literature as an effort to broaden the scope of precision medicine by extrap- olating it towards public health. By means of the “All of Us” (AoU) research pro- gram, launched by the National Institutes of Health in the U.S., PPH is being devel- oped based on health data shared through a broad range of digital tools. PPH is an emerging idea to harness the data collected for precision medicine (...) to be able to tai- lor preventive interventions for at-risk groups. The character of these data concern genetic identity, lifestyle and overall health and therefore affect the ‘intimacy’ of personhood. Through the concept of biological citizenship, we elucidate how AoU and its recruitment tactics, by resonating ‘diversity’, at the same time appeal to and constitute identity, defining individuals as ‘data sharing subjects’. Although PPH is called for; the type of bio-citizenship that is enacted here, has a particular definition, where participant recruitment focuses on ‘citizenship’ in terms of empowerment (front), it is the ‘bio’ prefix that has become the main focus in terms of research. i.e. biosubjectivities vs biocapital. This raises the question whether the societal chal- lenges that often underlie public health issues can be sufficiently dealt with based on the way ‘diversity’ is accounted for in the program. We suggest that the AoU still risks of harming underrepresented groups based on the preconditions and the design of the program. (shrink)

We all know that we have and are our bodies. But might it be possible to leave this common place? In the present article we try to do this by attending to the way we do our bodies. The site where we look for such action is that of handling the hypoglycaemias that sometimes happen to people with diabetes. In this site it appears that the body, active in measuring, feeling and countering hypoglycaemias is not a bounded whole: its boundaries (...) leak. Bits and pieces of the outside get incorporated within the active body; while the centre of some bodily activities is beyond the skin. The body thus enacted is not self-evidently coherent either. There are tensions between the body’s organs; between the control under which we put our bodies and the erratic character of their behaviour; and between the various needs and desires single bodies somehow try to combine. Thus to say that a body is a whole, or so we conclude, skips over a lot of work. One does not hang together as a matter of course: keeping oneself together is something the embodied person needs to do. The person who fails to do so dies. (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 Care of the Self is the third and possibly final volume of Michel Foucault’s widely acclaimed examination of "the experience of sexuality in Western society." Foucault takes us into the first two centuries of our own era, into the Golden Age of Rome, to reveal a subtle but decisive break from the classical Greek vision of sexual pleasure. He skillfully explores the whole corpus of moral reflection among philosophers and physicians of the era, and uncovers an increasing mistrust of (...) pleasure and growing anxiety over sexual activity and its consequences. (shrink)

Frontmatter -- VORWORT ZUR ERSTEN AUFLAGE -- VORWORT ZUR ZWEITEN AUFLAGE -- INHALT -- Erstes Kapitel. ZIEL UND GEGENSTAND DER UNTERSUCHUNG -- Zweites Kapitel. DER CARTESIANISCHE EINWAND UND DIE PROBLEMSTELLUNG -- Drittes Kapitel. DIE THESE -- Viertes Kapitel. DIE DASEINSWEISEN DER LEBENDIGKEIT -- Fünftes Kapitel. DIE ORGANISATIONSWEISEN DES LEBENDIGEN DASEINS. PFLANZE UND TIER -- Sechstes Kapitel. DIE SPHÄRE DES TIERES -- Siebentes Kapitel: Die Sphaere des Menschen -- NACHTRAG -- SACHREGISTER -- NAMENSREGISTER -- Backmatter.

The Body Multiple is an extraordinary ethnography of an ordinary disease. Drawing on fieldwork in a Dutch university hospital, Annemarie Mol looks at the day-to-day diagnosis and treatment of atherosclerosis. A patient information leaflet might describe atherosclerosis as the gradual obstruction of the arteries, but in hospital practice this one medical condition appears to be many other things. From one moment, place, apparatus, specialty, or treatment, to the next, a slightly different “atherosclerosis” is being discussed, measured, observed, or stripped away. (...) This multiplicity does not imply fragmentation; instead, the disease is made to cohere through a range of tactics including transporting forms and files, making images, holding case conferences, and conducting doctor-patient conversations. The Body Multiple juxtaposes two distinct texts. Alongside Mol’s analysis of her ethnographic material—interviews with doctors and patients and observations of medical examinations, consultations, and operations—runs a parallel text in which she reflects on the relevant literature. Mol draws on medical anthropology, sociology, feminist theory, philosophy, and science and technology studies to reframe such issues as the disease-illness distinction, subject-object relations, boundaries, difference, situatedness, and ontology. In dialogue with one another, Mol’s two texts meditate on the multiplicity of reality-in-practice. Presenting philosophical reflections on the body and medical practice through vivid storytelling, The Body Multiple will be important to those in medical anthropology, philosophy, and the social study of science, technology, and medicine. (shrink)