Book review: New pandemics, old politics: two hundred years of war on disease and its alternatives by Alex de Waal

In New Pandemics, Old Politics: Two Hundred Years of War on Disease and its Alternatives, Alex de Waal offers a new political history of epidemics, identifying and critiquing a repeated mobilisation of the ‘war metaphor’ of pandemic disease to show our persistent (mis-)framing of biological illness. The book is an extremely comprehensive and fascinating history of previous epidemics, their metaphors and manifestations, and a highly thought-provoking read in our current times, writes Hannah Farrimond. New Pandemics, Old Politics: Two Hundred Years of War on Disease and its Alternatives. Alex de Waal. Polity. 2021

Active ageing, emotional care and the threat of stigma:Identity management in older adults using sleeping medication long-term

This is the author accepted manuscript. The final version is available from SAGE Publications via the DOI in this record.Amid fears about the medicalization of old age, the high prevalence of sleeping medication use in older cohorts is a significant public health concern. Long-term use is associated with a plethora of negative effects, such as cognitive impairment and risk of addiction. However, little is known about the lived experience of older adults using sleeping medication longer term. Episodic interviews lasting approximately 90 minutes were conducted with 15 independently living adults, aged 65-88, who were using sedative-hypnotic or tricyclic sleeping medication for over 11 years on average. Thematic analysis shows that participants divided their rationale for use into two temporal periods: 1) to ensure physical ability in the daytime and 2) to ensure emotional stability at night. Long-term sleeping medication was thus characterized as a form of ‘emotional self-management’ of the negative emotions associated with later life, blotting out feelings of loss and loneliness by inducing sleep. Participants feared loss of access to their medication ‘supply’, employing strategies to ensure its continuity, whilst expressing shame about their dependence. However identity management, in the form of explanations, minimizations and social comparisons, functioned to downplay their addiction. Through this, long-term sleeping medication users were able to elude the spoiled identities and multiple stigma of both the ‘out of control’ addict and the unsuccessful older adult by asserting a positive identity; that of the ‘new’ older adult, actively medicating for success both day and night

Beyond beliefs: risk assessment technologies shaping patients' experiences of heart disease prevention

Social science research on lifestyle-related diseases typically focuses on patients' understandings and beliefs and takes the clinical risk for granted. We interviewed 30 healthy UK patients at high risk of heart disease, recruited from a family history trial at 2weeks and 6months after a discussion with a clinician about their risk, lifestyle and medications. The participants took four different paths: (i) pharmaceutical (most common, risk reduction with cholesterol lowering statins), (ii) mixed (statins and behaviour change), (iii) behavioural (behaviour change, focus on wellbeing) and (iv) 'lost' (no prevention, difficult social/personal circumstances). Drawing on Berg we argue that coronary heart disease (CHD) risk assessment technologies are formal tools that generate, rather than represent, high risk in a way that patients often experience lifestyle change as futile, because it rarely reduces their cholesterol to targets defined by the tools. We suggest social scientists studying incipient or 'proto-diseases', such as CHD risk, should not only focus on understandings but also investigate the technologies (and the associated guidelines, policies, clinical practice and pharmaceutical industry operations) that generate incipient diseases and patients' experiences of them. However, technologies do not determine experience and we also discuss elements that direct patients down other than the pharmaceutical path. © 2011 The Authors. Sociology of Health & Illness © 2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd

Making sense of being at 'high risk' of coronary heart disease within primary prevention

Current NHS policy advocates screening to identify individuals at ‘high risk’ of cardiovascular disease (CHD) in primary care. This paper utilizes the work of Radley to explore how ‘high risk’ of CHD patients make sense of their new risk status. Results are presented here from a nested qualitative study within a quantitative randomized trial of a CHD risk intervention in primary care. ‘Discovery’ interviews were conducted with ‘high risk’ participants (n=38, mean age=55) two weeks after intervention and thematically analyzed. In response to perceived threat, many participants sought to both ‘minimize’ and ‘normalize’ their risk status. They also reported intentions to act, particularly concerning dietary change and exercise, although less so for smoking amongst the lower SES participants. Such perceptions and intentions were contextualized within the lifecourse of later middle-age, so that both being at risk, and being treated for risk, were normalized as part of growing older. Social position, such as gender and SES, was also implicated. CHD risk interventions should be context-sensitive to the life-course and social position of those who find themselves at ‘high risk’ of CHD in later middle-age

Making sense of being at 'high risk' of coronary heart disease within primary prevention

types: Journal ArticleCurrent National Health Service policy advocates screening to identify individuals at 'high risk' of cardio-vascular disease (CHD) in primary care. This article utilizes the work of Radley to explore how 'high risk' of CHD patients make sense of their new risk status. Results are presented here from a nested qualitative study within a quantitative randomized trial of a CHD risk intervention in primary care. 'Discovery' interviews were conducted with 'high risk' participants (n = 38, mean age = 55) two weeks after intervention and thematically analysed. In response to perceived threat, many participants sought to both 'minimize' and 'normalize' their risk status. They also reported intentions to act, particularly concerning dietary change and exercise, although less so for smoking amongst the lower socio-economic status participants. Such perceptions and intentions were contextualized within the life-course of later middle-age, so that both being at risk, and being treated for risk, were normalized as part of growing older. Social position, such as gender and SES, was also implicated. CHD risk interventions should be context-sensitive to the life-course and social position of those who find themselves at 'high risk' of CHD in later middle-age

A Q-methodological study of 'smoking identities'

publication-status: Publishedtypes: ArticleIn contrast to the psychological literature on adolescent smoking, little research has investigated the social identities of adult smokers. This study aimed to identify shared ‘smoking identities’ amongst a sample of 64 British smokers from different socio-economic groups using Q-methodology. Participants were asked to sort 70 items concerning smoking and smokers according to their agreement/disagreement with them. The 64 Q-sorts were then subjected to a by-person factor analysis yielding six factors, with the first four interpretable factors being presented here. Each factor is understood to represent a distinct ‘identity position’. The first two, the ‘addicted’ smoker, and the ‘in control’ smoker, oriented around a biomedical model of smoking as an addictive health risk. The final two, the ‘no big deal’ smoker and the ‘proud’ smoker reflected alternative understandings and values. The identity positions also differed in the extent to which smoking was considered a core part of self-identity. Unpacking the ‘smoking identities’ of current smokers offers the opportunity to devise targeted health promotion.Economic and Social Research Counci

E-cigarette regulation and policy: UK vapers’ perspectives

ArticleBackground and aims The rapid increase in use of electronic cigarettes (e-cigarettes) has created an international policy dilemma concerning how to use these products. This study assesses the types of beliefs that e-cigarette users in the UK may hold concerning regulation. Design Qualitative thematic analysis of written answers to open-ended questions. Setting UK, questionnaire conducted by post, 44% recruited from online forums/56% non-online. Participants Fifty-five UK vapers, 55% male, mean age 46, 84% sole users of e-cigarettes, 95% vaping daily. Measurements Open-ended questions on regulatory and policy options. Findings ‘Protecting youth’ was seen as a fundamental regulatory requirement which should be achieved through childproofing, age limits, no advertising aimed at children and health warnings about addictiveness of nicotine, but not the restriction of flavours. There was little support for regulating e-cigarettes as medicines or limiting the strength of nicotine liquids. In terms of public use, participants argued against a blanket ban on public vaping given perceptions of a lack of scientific evidence of harm. However, they supported the principle of autonomy, that individuals and organizations have the right to restrict vaping. Some participants suggested banning vaping in places such as schools, hospitals or around food, in line with current smoking norms. Vapers’ regulatory positions were accompanied by political concerns about the use (and misuse) of scientific evidence. Conclusions With regard to regulation of e-cigarettes, issues that are salient to UK vapers may include the need for youth protection, regulation as medicines, strength of e-liquids, bans on public vaping and concerns about the misuse of scientific evidence

Neurofibromatosis Type 1 (NF1) : family experiences and healthcare management of a genetic syndrome characterised by a highly uncertain phenotype

Neurofibromatosis Type 1 (NF1) is a dominantly inherited disorder (births incidence: 1/3000) with a high spontaneous mutation rate. NF1 has been described as a condition without parameters; physical features, cognitive symptomatology, and complications such as malignancy, are highly variable, both within and between families, and over the lifetime of affected individuals. This thesis explores the significance of the recent classifications of NF1 as a ‘genetic syndrome’, in terms of the subjecthood of affected individuals, their family experiences and the way it is managed within the healthcare system. The research is based on qualitative semi-structured interviews of NF1 individuals, their families (n=30) and healthcare professionals who work with NF1 (n=11) and employs Grounded Theory and Narrative Analysis inspired methods of analysis. As such, it provides an empirical investigation of many of the sociological theories which have been developed in response to genetic disease, particularly genetic responsibility, biocitizenship and the medicalization of the family. NF1 was still experienced by patients and treated by the healthcare system, as a condition without parameters i.e., as a disparate set of symptoms with uncertain meaning, rather than as a ‘whole’. The majority of the respondents - regardless of the severity of NF1 - rejected NF1 genetic identities, employing diverse downplaying strategies to normalise it. NF1 was salient at certain critical junctures in individuals’ lifecourses, especially in relation to reproductive choices, disclosure and management of pressing symptoms. Family experiences with genetic conditions, the relations of family or kinship, health behaviours, familial surveillance and disclosure did not necessarily follow the lines of biomedical knowledge and genetic inheritance. The analysis also revealed a degree of mirroring between the structure of the healthcare provision for NF1 and patients’ constructions of the condition, for example the lack of illness identity. The example of NF1 shows that the identification of the genetic basis of a condition does not necessarily provide patients and healthcare professionals with more parameters to manage it.EThOS - Electronic Theses Online ServiceGBUnited Kingdo