At the boundaries of food and medicine: the genesis and transformation of the “functional food” markets in France and Europe

Functional foods have swept across France and Europe since the late 1980s. Margarines enriched with omega 3 or phytosterols, yoghurts enriched with bifidus or vitamin-rich food supplements... these foods with health claims have reopened the boundary erected over the course of the twentieth century between the markets for medicines, whose primary function is to treat the sick, and those for foods, whose primary function is to meet the nutritional needs of healthy people. They thus raise many issues for regulators, producers, distributors and consumers. Are they health products that can usefully contribute to the prevention of chronic diseases or marketing manipulations that are not of any health interest? Should they be regulated and marketed as drugs, as food or as a separate category ? Drawing on significant contributions in economic history and sociology, this article analyzes the consequences of the classification of these products as medicines, foods or dietary supplements on their valuation and the structure of their markets. It also focuses on the boundary work in which industry and regulatory actors engage in order to “(re)classify” these products, and thereby “(re)structure” the markets in which they circulate. The first part of the article describes the process that led France to establish a boundary between the previously intertwined markets for medicines and foods over the course of the twentieth century, which has been blurred by the appearance of functional foods since the beginning of the 1980s. The second part deals with the efforts of French and European regulatory authorities and industry actors to renegociate these boundaries between the markets for medicines and foods bearing nutritional and health claims. We conclude this second part with a discussion of the consequences of this reframing for the reorganization of markets and the reevaluation of the health benefits and commercial advantages of these products

At the boundaries of food and medicine: the genesis and transformation of the “functional food” markets in France and Europe

Functional foods have swept across France and Europe since the late 1980s. Margarines enriched with omega 3 or phytosterols, yoghurts enriched with bifidus or vitamin-rich food supplements... these foods with health claims have reopened the boundary erected over the course of the twentieth century between the markets for medicines, whose primary function is to treat the sick, and those for foods, whose primary function is to meet the nutritional needs of healthy people. They thus raise many issues for regulators, producers, distributors and consumers. Are they health products that can usefully contribute to the prevention of chronic diseases or marketing manipulations that are not of any health interest? Should they be regulated and marketed as drugs, as food or as a separate category? Drawing on significant contributions in economic history and sociology, this article analyzes the consequences of the classification of these products as medicines, foods or dietary supplements on their valuation and the structure of their markets. It also focuses on the boundary work in which industry and regulatory actors engage in order to “(re)classify” these products, and thereby “(re)structure” the markets in which they circulate. The first part of the article describes the process that led France to establish a boundary between the previously intertwined markets for medicines and foods over the course of the twentieth century, which has been blurred by the appearance of functional foods since the beginning of the 1980s. The second part deals with the efforts of French and European regulatory authorities and industry actors to renegociate these boundaries between the markets for medicines and foods bearing nutritional and health claims. We conclude this second part with a discussion of the consequences of this reframing for the reorganization of markets and the reevaluation of the health benefits and commercial advantages of these products

Les représentations sociales du corps « gros »

This article describes the social representations of “overweight” and “obesity” of practitioners (doctors, dietitians, psychologists) and patients (people medically categorized “overweight” or “obese”). The analysis of the terms they use, of their moral beliefs, and of their social and aesthetic norms helps to explain why people define many situations as “stigmatizing” or “discriminating”. The medical, dietetic, and psychological professionals describe the complexity of weight management, their professional dissatisfactions, and what they expect from their patients. Analyzing social representations sheds light on the gap between beliefs and mutual expectations and how these impact the management of overweight and obese patients. This analysis is also a way to illustrate the diversity of each studied group, in terms of professional background or daily-life experiences, and their consequences on medical interactions

Être grosse. Du corps discréditable au corps discrédité

En nous appuyant sur la réalisation d’une soixantaine d’entretiens semi-directifs, nous analysons les situations de stigmatisation et de discrimination selon le poids et comparons ainsi le vécu d’enquêtées catégorisées médicalement « en surpoids » ou « obèses ». Ces différences selon la corpulence sont modulées par le genre, le milieu social ou l’âge des enquêtées. Face aux épisodes de stigmatisation, qui rendent l’ordre des interactions inégalitaires, les enquêtées mettent en place des répertoires d’actions pour « sauver la face ». Elles sont plus démunies face aux expériences de discrimination, en particulier professionnelles, ces dernières ayant pourtant des conséquences importantes sur leur statut social. La description de ces situations, et des réactions possibles, permet de montrer la fréquence, la virulence et l’ampleur de ces actes dans le contexte français.Based on sixty semi-directive interviews, this article analyses situations of weight-based stigmatization and discrimination and compares experiences of interviewees categorized as “overweight” or “obese” by health professionals. These differences are shown to be subject to variation by the interviewees' gender, class, and age. During the episodes of stigmatization in which an unequal interaction order is produced, the interviewees, however, deploy strategies of "saving face". The article shows that they are particularly helpless in the face of discrimination at the workplace, a key site of defining their social status. The description of these situations highlights the frequency, virulence, and extent of such acts in French society

At the boundaries of food and medicine: the genesis and transformation of the “functional food” markets in France and Europe

Functional foods have swept across France and Europe since the late 1980s. Margarines enriched with omega 3 or phytosterols, yoghurts enriched with bifidus or vitamin-rich food supplements... these foods with health claims have reopened the boundary erected over the course of the twentieth century between the markets for medicines, whose primary function is to treat the sick, and those for foods, whose primary function is to meet the nutritional needs of healthy people. They thus raise many issues for regulators, producers, distributors and consumers. Are they health products that can usefully contribute to the prevention of chronic diseases or marketing manipulations that are not of any health interest? Should they be regulated and marketed as drugs, as food or as a separate category ? Drawing on significant contributions in economic history and sociology, this article analyzes the consequences of the classification of these products as medicines, foods or dietary supplements on their valuation and the structure of their markets. It also focuses on the boundary work in which industry and regulatory actors engage in order to “(re)classify” these products, and thereby “(re)structure” the markets in which they circulate. The first part of the article describes the process that led France to establish a boundary between the previously intertwined markets for medicines and foods over the course of the twentieth century, which has been blurred by the appearance of functional foods since the beginning of the 1980s. The second part deals with the efforts of French and European regulatory authorities and industry actors to renegociate these boundaries between the markets for medicines and foods bearing nutritional and health claims. We conclude this second part with a discussion of the consequences of this reframing for the reorganization of markets and the reevaluation of the health benefits and commercial advantages of these products

Aux frontières de l'aliment et du médicament: Genèse et transformations du marché des "alicaments" (1990-2016)

Cette étude entend analyser la dynamique de formation et d’institutionnalisation des marchés d'alicaments, aux frontières du médicament et de l’aliment, en France depuis le début des années 1990. En nous appuyant sur les importants apports de l’histoire et de la sociologie économiques , nous entendons montrer en quoi la qualification de ces produits comme des médicaments, des aliments ou des compléments alimentaires et l’évaluation de leurs bénéfices et de leurs risques pour la santé a d’importantes conséquences sur l’organisation de leurs marchés et sur les valeurs qui leurs sont prêtées. Les « alicaments » constituent des objets d’étude particulièrement intéressants pour interroger ces liens entre les processus de sanitarisation du marché , visant à faire du marché le support d’une promotion de la santé publique, et de marchandisation de la santé, visant à faire de la santé publique un vecteur d’organisation et de valorisation marchandes. En effet, ces produits ont remis en cause les frontières érigées tout au long du vingtième siècle entre le marché des médicaments, dont la fonction première serait de soigner des personnes malades et celui des aliments, dont la fonction première serait de répondre aux besoins nutritionnels de personnes en bonne santé. Cette contribution entend précisément interroger ces « jeux aux frontières » auxquels se sont livrés les industriels et les autorités de régulation pour « (re)qualifier » ces produits et ainsi « (re)-structurer » les marchés sur lesquels ils circulent

La trajectoire des enfants inclus dans la recherche : une expérience en termes de ruptures et de continuités

This article explores the consequences for families whose children are included in a research protocol in the context of precision medicine development. While the trajectory of children with advanced cancers is part of a series of bifurcations related to the different therapeutic choices proposed and their organizational consequences, these bifurcations are not necessarily experienced as ruptures by the families. The experience of parents and children is shaped by their understanding of what clinical research is about, but also by the organizational, economic, or emotional resources that allow them to re-establish continuity in a disrupted daily life. This search for continuity persists during the end-of-life phase of the child’s life, even if the child’s death is a major biographical rupture for the whole family

Entre catégorie médicale et expérience située : quelle(s) spécificité(s) des cancers pédiatriques ?

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