Patient Advocacy, Drug Promotion, and the Feminist Paradox: An Analysis of the Canadian Pain Coalition

Healthcare has changed significantly over the past few decades with the emergence of neoliberalism as a dominant ideology informing policy. This paper examines the Canadian Pain Coalition’s (CPC) conceptualization of chronic pain and its treatment in the context of neoliberalism. Through content analysis of the CPC’s online materials, we show how the advocacy group constructs pain as an individual’s responsibility and a physical disease that can be managed primarily with pharmaceutical medication.  Drawing on insights from the social determinants of health and feminist literatures, we suggest that the CPC’s construction of pain as a physical disease, an individual responsibility, and its emphasis on pharmaceutical treatment is inadequate in addressing the complex social, economic, and physical needs of people living with chronic pain.  Taking up Susan Markens’ concept of the “feminist paradox,” we suggest that there is a necessary tension in the construction of pain as disease.  On the one hand, it is constructed in terms of providing access to treatments, while on the other, it potentially medicalizes people living with chronic pain.  Finally, we discuss how the CPC does not adequately address the side of the tension concerning medicalization, given the strong association between the CPC and the pharmaceutical companies

From the Incinerator to the Bank: A Feminist Qualitative Study of Private Cord Blood Banking in Canada

This is a feminist, qualitative study of private umbilical cord blood banking in Canada. Drawing on in-depth, semi-structured interviews with 12 women who banked cord blood, 6 key informants from 4 different private cord blood banks, and 3 healthcare professionals, I consider what private cord blood banking can tell us about contemporary biopolitics, the production of biovalue in corporeal materials, the promise of “biological insurance,” and the social actor of neoliberalism. My research makes several key contributions to sociological literature on stem cell science, health and contemporary biopolitics. First, I make a feminist, empirical contribution to social science scholarship on private cord blood banking specifically. Second, I expand on the biovalue literature by demonstrating the social production of biovalue in a specific cord blood unit. I show that the production of biovalue in cord blood units is a social process that involves tensions and negotiations between women, private banks and clinicians across different expert discourses and profane knowledges. Third, I critically examine the metaphor of private cord blood banking as “biological insurance.” Private cord blood banks emphasize the future, speculative promises of regenerative stem cell therapies and market their services as a form of insurance. Contrary to this position, I show how in some cases cord blood fails to provide the protection it promises. Fourth, this study challenges contemporary literature on the active subject in health. I argue that women’s experiences of cord blood banking show that the conventional interpretation of the active subject as a rational, calculating subject that engages in contemporary health strategies in a hopeful manner requires revision. I show that women act as precautionary actors who bank in a context of uncertainty and fear. By providing an in-depth, empirical examination of women’s experiences of private cord blood banking, I offer a feminist, critical account of a contemporary biopolitical strategy in the Global North: health optimization through private tissue storage. I challenge biopolitics scholarship that presents an over-generalized, acritical account of contemporary biopolitics and argue for greater analytic and empirical attention to the everyday experiences of people who engage in health optimizing practices

‘Wannabe Toxic-Free?’ From Precautionary Consumption to Corporeal Citizenship

Ecological citizens are increasingly encouraged to adopt ‘precautionary consumption’ – a set of practices aimed at shielding them from the potential health harms of exposures to everyday toxics. The utility and the effects of precautionary consumption in relation to common chemical exposures are investigated. Precautionary consumption is not only of questionable utility, but is fundamentally misguided as an approach for inspiring antitoxics organizing. The failure of this approach is in part due to its assumption of a naturally bounded, autonomous individual who is able to maintain an impermeable boundary between herself and the environment. Drawing on the work of material feminist theorists, it is argued that Gabrielson and Parady’s notion of corporeal citizenship, an approach that places bodies into a complex web of material, ecological relations entangled with the social, offers several strategic advantages for framing resistance strategies

“You can’t just let health care happen”: Unpaid caregiving of brain injured spouses in a context of marketization in British Columbia

Drawing on feminist approaches, this thesis utilizes in-depth interviews to examine unpaid caregiving of a brain injured spouse in a context of health care marketization in BC. In this context of decreasing public support and cuts to services, this study focuses on caregiving practices which emerge at gaps in health services at three sites: the hospital, accessing rehabilitation, and the community. Caregivers provide direct care in hospitals in response to inadequate healthcare, construct their spouses as “deserving” of scarce rehabilitation services, and provide care in the community with limited supports. Caregivers’ advocacy care work is critical for gaining access to services and those with greater resources are better positioned to provide advocacy and other forms of care. Overall, gender influences the discourses caregivers draw upon to describe their caregiving practices. I conclude with a discussion of policy considerations which address some of the effects of marketization on unpaid caregiving

Clinicians’ views and expectations of human microbiome science on asthma and its translations

Human microbiome science examines the microbiota that live in and on the human body and their role in human health. This paper examines clinicians’ views and expectations of microbiome science in asthma care. Drawing on qualitative interviews with 10 clinicians in Canada, we explore their perspectives for insights into translation of human microbiome science. The emphasis on novelty in much microbiome scholarship, we suggest, does not account fully for the ways in which microbiome science translations may be taken up in multiple ways that are both disruptive to and continuous with contemporary biomedicine. We suggest that clinicians drew on scientific discourses of “evidence” and “facts” as a form of boundary work to re-establish a separation between western biomedicine and alternative health practitioners, and clinical expertise and lay knowledge. We conclude with a discussion of human microbiome science and the emergence of post-Pasteurian modes of health in western biomedicine

‘Wannabe Toxic-Free?’ From Precautionary Consumption to Corporeal Citizenship

Ecological citizens are increasingly encouraged to adopt ‘precautionary consumption’ – a set of practices aimed at shielding them from the potential health harms of exposures to everyday toxics. The utility and the effects of precautionary consumption in relation to common chemical exposures are investigated. Precautionary consumption is not only of questionable utility, but is fundamentally misguided as an approach for inspiring antitoxics organizing. The failure of this approach is in part due to its assumption of a naturally bounded, autonomous individual who is able to maintain an impermeable boundary between herself and the environment. Drawing on the work of material feminist theorists, it is argued that Gabrielson and Parady’s notion of corporeal citizenship, an approach that places bodies into a complex web of material, ecological relations entangled with the social, offers several strategic advantages for framing resistance strategies

Toxic Conceptions: The Assessment and Regulation of Male-Mediated Transgenerational Effects of Chemical Exposures

Scientific research increasingly confirms the potential for health effects to be transmitted from men to their offspring as a result of men’s exposures, prior to conception, to endocrine-disrupting chemicals. This article examines how “male-mediated transgenerational effects” are addressed by the discretionary, risk-based approach to chemical assessment enabled under the Canadian Environmental Protection Act, 1999. Informed by Cynthia Daniels’ theory of reproductive masculinity, the authors critically examine recent assessments of two classes of everyday toxics ubiquitous in Canadian households—phthalates and brominated flame retardants.** In failing to give weight to emerging evidence of male-mediated transgenerational effects, these assessments arguably reproduce gendered assumptions, situating men as secondary to reproduction and reinforcing the idea that responsibility for toxic exposures is a maternal matter. The authors argue that Canadian governance of endocrine-disrupting chemicals would be improved by greater attention to how men’s exposures to toxic chemicals may contribute to male-mediated transgenerational effects. Further, the article identifies deficiencies in the legislative scheme that contribute to ongoing failures to meaningfully assess or regulate endocrine-disrupting chemicals

Toxic Conceptions: The Assessment and Regulation of Male-Mediated Transgenerational Effects of Chemical Exposures

Scientific research increasingly confirms the potential for health effects to be transmitted from men to their offspring as a result of men’s exposures, prior to conception, to endocrine-disrupting chemicals. This article examines how “male-mediated transgenerational effects” are addressed by the discretionary, risk-based approach to chemical assessment enabled under the Canadian Environmental Protection Act, 1999. Informed by Cynthia Daniels’ theory of reproductive masculinity, the authors critically examine recent assessments of two classes of everyday toxics ubiquitous in Canadian households—phthalates and brominated flame retardants.** In failing to give weight to emerging evidence of male-mediated transgenerational effects, these assessments arguably reproduce gendered assumptions, situating men as secondary to reproduction and reinforcing the idea that responsibility for toxic exposures is a maternal matter. The authors argue that Canadian governance of endocrine-disrupting chemicals would be improved by greater attention to how men’s exposures to toxic chemicals may contribute to male-mediated transgenerational effects. Further, the article identifies deficiencies in the legislative scheme that contribute to ongoing failures to meaningfully assess or regulate endocrine-disrupting chemicals

Sexual risk behavior questions: Understanding and mitigating donor discomfort

Background Blood operators are working to improve donor screening and eligibility for gay, bisexual and other men who have sex with men (gbMSM), and trans and nonbinary donors. Many consider screening all donors for specific sexual risk behaviors to be a more equitable approach that maintains the safety of the blood supply. Feasibility considerations with this change include ensuring donor understanding of additional sexual behavior questions and minimizing donor loss due to discomfort. Study design and methods Qualitative one-on-one interviews were conducted with Canadian whole blood and plasma donors (N = 40). A thematic analysis was conducted to assess participants' understandings of the questions, examine their comfort/discomfort, and identify strategies to mitigate donor discomfort. Results All participants understood what the sexual behavior questions were asking and thought the questions were appropriate. Themes related to comfort/discomfort include: their expectations of donor screening, social norms that they bring to donation, whether their answer felt like personal disclosure, knowing the reasons for the question, trusting confidentiality, confidence in knowing their sexual partner's behavior, and potential for the question to be discriminatory. Strategies to mitigate discomfort include: providing an explanation for the questions, forewarning donors of these questions, reducing ambiguity, and using a self-administered questionnaire. Conclusion While many blood operators and regulators view the move to sexual behavior–based screening for all donors as a significant paradigmatic shift, donors may not perceive additional sexual behavior questions as a significant change to their donation experience. Further research is needed to evaluate the effectiveness of strategies to mitigate donor discomfort