As opioid fatalities rise in North America, the need to improve the supports available to those who are dependent on opioids and pregnant has become more urgent. This paper discusses the social organisation of drug treatment supports for those who are pregnant, using Canadian clinical practice guidelines (CPGs) for methadone maintenance treatment (MMT) as a case study. Pregnant patients are a priority population for MMT, both in Canada and internationally; the regulatory bodies that oversee MMT in Canada are the provincial Colleges of Physician and Surgeons and Health Canada. The paper analyses MMT CPGs published by these agencies, comparing their general recommendations to those specific to pregnant patients. We demonstrate that the guidelines address few treatment considerations for pregnant patients, other than improved birth outcomes and child welfare, despite acknowledging their more complex needs. Drawing on social science studies of gender and drugs, we argue that MMT CPGs therefore perpetuate the intensified surveillance and foetal prioritisation that have long generated barriers to care for opiate-dependent pregnant patients. We also discuss how and why the CPGs ultimately only reinforced these current limitations in the drug treatment sector.

This paper takes a critical look at the role of chronobiology in society today, with particular reference to its entanglements with health and medicine and whether or not this amounts to the (bio)medicalisation of our bodily rhythms. What we have here, we show, is a complex unfolding storyline, within and beyond medicine. On the one hand, the promises and problems of these circadian, infradian and ultradian rhythms for our health and well-being are now increasingly emphasised. On the other hand, a variety of new rhythmic interventions and forms of governance are now emerging within and beyond medicine, from chronotherapies and chronopharmacology to biocompatible school and work schedules, and from chronodiets to the optimisation of all we do according to our \'chronotypes\'. Conceptualising these developments, we suggest challenges us to think within and beyond medicalisation to wider processes of biomedicalisation and the biopolitics of our body clocks: a vital new strand of chronopolitics today indeed which implicates us all in sickness and in health as the very embodiment of these rhythms of life itself. The paper concludes with a call for further research on these complex unfolding relations between chronobiology, health and society in these desynchronised times of ours.

Health practices are shaped by gender relations and constructs. Utilising qualitative data, this study explores a shift in medication practices among gay men living with HIV (GMLH) in light of changing HIV/AIDS responses in Taiwan. In the 1980s and 1990s, the mobilisation of moralising discourses forged a gender hierarchy that subordinated HIV-positive gay males. In the 2000s, new state programmes on HIV/AIDS were implemented to enhance patients\' adherence to treatment, but GMLH often expressed ambivalence towards medication, which could lead to HIV disclosure and, consequently, social exclusions under the gender hierarchy. Starting in the 2010s, the knowledge of HIV \'treatment as prevention\' and a policy on early treatment have offered a new path for GMLH to navigate gender power dynamics and to strive towards an inclusive social life by taking medicine and optimising health, which facilitates a biomedicalisation of subordinated masculinity. This study contributes to the scholarship on HIV/AIDS by underscoring the significance of biomedicine for configuring masculine identities and practices among a subordinated group of men, as well as by highlighting the gender power relations and everyday \'nonbiomedical\' negotiating practices that legitimise biomedicalisation.

There has been a notable increase in the use of statins in people without cardiovascular disease but who may be at risk in the future. The majority of statin users now fall into this category but little research has focused exclusively on this group. Debate has ensued regarding medicating asymptomatic people, and processes described variously as medicalisation, biomedicalisation and pharmaceuticalisation are used to explain how this happens. These overlapping and interrelated processes require issues to be \'problemised\' as medical problems requiring medical solutions given the prevailing understandings of health, risk and disease. However, current understandings of risk and disease are not simply the result of technological and scientific advances, they are also socially constructed. We interviewed members of the public, GPs and others, and found that rather than high cholesterol being seen as one of several risk factors that contributes to heart disease, it tended to be promoted simplistically to the status of a disease needing treatment of itself. Statins were justified by those taking them as different to \'unnecessary medicines\'. However, some participants demonstrated resistance to statins, worried about over-medicalisation and deviated from accepted practices, indicating a complex \'muddling through\' in the face of uncertainty.

There is mounting urgency regarding the mental health of gay, bisexual and other men who have sex with men (GBM). We examined how GBM are understanding the relationship between HIV and their mental health given the increasing biomedicalisation of HIV prevention and care. Our Grounded Theory analysis derived from qualitative interviews with 24 GBM living in Toronto, Canada, including both HIV-negative and HIV-positive men. Participants understood biomedical advances, such as undetectable viral load and pre-exposure prophylaxis (PrEP), as providing some relief from HIV-related distress. However, they offered ambivalent perspectives on the biomedicalisation of HIV. Some considered non-HIV-specific stressors (e.g. unemployment, racial discrimination) more significant than HIV-related concerns. These men expressed HIV-related distress as being under control due to biomedical advances or as always negligible when compared to non-HIV-specific stressors. Others emphasised the ongoing mental health implications of HIV (e.g. enduring risk and stigma). We describe a tension between optimistic responses to biomedicine\'s ability to ease the psychosocial burdens associated with HIV and the inability for biomedicine to address the social and economic determinants driving the dual epidemics of HIV and mental distress amongst GBM. We argue for more socio-material analysis over further sexual behavioural analysis of GBM mental health disparities.

Previous research demonstrates that biomedicalisation and diagnostic processes are intertwined in American mental health care, but few studies examine practitioners\' negotiations. This study examines how Mental Health Practitioners (MHPs) negotiate the Diagnostic and Statistical Manual (DSM), diagnosis, standardisation and biomedicalisation-in-practice. Feminist grounded theory analysis of 42 semi-structured interviews with licensed adolescent MHPs reveals accounts of discursive, everyday resistance to the DSM technology and standardisation, which I regard as key aspects of biomedicalisation. Findings demonstrate MHPs seemingly practice what I term diagnostic dissonance: a deep conflict between their professional theoretical orientations and the biomedical model legitimated in the DSM technology and insurers\' diagnostic standardisation. MHPs enact dissonance by undermining the DSM, working around standardisation and by coding the social. Coding the social refers to the employment of V-codes - illegitimate secondary diagnoses - which convey social and relational conditions of mental distress. MHPs\' contestations of the DSM and standardisation are responses to a healthcare infrastructure that decontextualises mental health. Practitioner resistance to biomedicalisation-in-diagnosis is important because the biomedicalisation of mental health takes focus away from the social and relational conditions and solutions to individual and community health and illness.

Drawing on testimonies from oral history interviews, this paper analyses the implications of pre-exposure prophylaxis (PrEP) practices for gay men in England. Through perspectives on biomedicalisation, the paper focuses on three aspects relevant to the construction of technoscientific identities in the realm of HIV prevention: (i) the question of agency of PrEP users in the context of what has been defined as a biomedical intervention, (ii) practices of freedom framed within neoliberal narratives of personal responsibility versus responsibilisation and (iii) the governance of risk in the era of biomedicalisation. The paper concludes that biomedical governmentalities, even those shaped by the rhetoric of personal responsibility, can be understood as rationalities linked more to solidarity and care of the other. Despite this, the use of PrEP in England is also giving way to the configuration of new sexual scenarios shaped by zero-risk mentalities. It will be important to remain alert to the implications of zero-risk scenarios for HIV-related stigma.RésuméEn s\'appuyant sur des témoignages provenant d\'entretiens centrés sur des histoires orales, cet article analyse les implications des pratiques de la PrEP chez les hommes gays en Angleterre. À travers les points de vue sur la bio-médicalisation, il se concentre sur trois aspects de la construction des identités technoscientifiques dans le royaume de la prévention du VIH : i) la question de la capacité à agir des utilisateurs de la PrEP dans le contexte de ce qui a été défini comme une intervention biomédicale, ii) les pratiques de la liberté, encadrées par les récits néolibéraux sur la responsabilité personnelle, versus la responsabilisation, et iii) la gouvernance du risque à l\'ère de la bio-médicalisation. En conclusion de leur article, les auteurs soutiennent que les << gouvernementalités >> biomédicales, y compris celles qui sont déterminées par la rhétorique de la responsabilité personnelle, peuvent être comprises comme des rationalités plus en rapport avec la solidarité et le souci des autres. Malgré cela, l\'usage de la PrEP en Angleterre laisse la place à la configuration de nouveaux scénarios sexuels déterminés par les mentalités du risque zéro. Il est important de rester attentif aux implications des scénarios du risque zéro au regard du stigma lié au VIH.ResumenA partir de testimonios obtenidos a través de entrevistas de historia oral, el presente artículo analiza las repercusiones de la PrEP (profilaxis preexposición para el vih, por sus iniciales en inglés) en las prácticas de hombres gais en Inglaterra. Partiendo de perspectivas sobre la biomedicalización, el artículo se centra en tres aspectos pertinentes a la construcción de identidades tecnocientíficas en el ámbito de la prevención del vih: i) la cuestión de la gestión (agency) de los usuarios de la PrEP en un contexto identificado como de intervención biomédica; ii) las prácticas de libertad enmarcadas en narrativas neoliberales de responsabilidad personal versus responsabilización; iii) el manejo del riesgo en la era de la biomedicalización. El artículo concluye que los manejos biomédicos, incluso aquellos moldeados por la retórica de responsabilidad personal, pueden entenderse como racionalidades vinculadas más con la solidaridad y el cuidado de los demás. A pesar de esto, el uso de la PrEP en Inglaterra está cediendo espacio a la configuración de nuevos escenarios sexuales determinados por esquemas mentales de riesgo cero. Debemos permanecer atentos ante las implicaciones que conllevan los escenarios riesgo cero para el estigma vinculado con el vih.

Injury is a conspicuous feature of the practice and public spectacle of contemporary elite sports. The paper argues that the \'biomedicalisation\' thesis (medico-industrial nexus, techno-scientific drivers, medical optimisation, biologisation, the rise of evidence and health surveillance) goes some way to capturing the use in elite sports injury of some highly specialised mainstream therapies and some highly maverick biological therapies, which are described. Nevertheless, these main strands of biomedicalisation do not capture the full range of these phenomena in the contexts of sports medicine and athletes\' practices in accessing innovative, controversial therapies. Drawing on multi-method qualitative research on top-level professional football and cycling in the UK, 2014-2016, we argue that concepts of \'magic\' and faith-based healing, mediated by notions of networking behaviour and referral systems, furnish a fuller explanation. We touch on the concept of \'medical pluralism\', concluding that this should be revised in order to take account of belief-based access to innovative bio-therapies amongst elite sportspeople and organisations.

In Sweden as well as in other western countries persons with trans experiences have to go through a clinical evaluation in order to get access to gender-confirming medical procedures. The aim of this study is to analyse care-users\' experiences of navigating and negotiating access to gender-confirming medical procedures in Sweden. Biomedicalisation is used as a theoretical framework in order to analyse how technoscientific and neoliberal developments are parts of constructing specific experiences within trans-specific care. Constructivist grounded theory was used to analyse 14 interviews with persons having experiences of, or considering seeking, trans-specific healthcare. The participants experienced trans-specific healthcare as difficult to navigate because of waiting times, lack of support, provider ignorance and relationships of dependency between healthcare-users and providers. These barriers pushed the users to take responsibility for the care process themselves, through ordering hormones from abroad, acquiring medical knowledge and finding alternative support. Based on the participants\' experiences, it can be argued that the shift of responsibility from care-providers to users is connected to a lack of resources within trans-specific care, to neoliberal developments within the Swedish healthcare system, but also to discourses that frame taking charge of the care process as an indicator that a person is in need of or ready for care. Thus, access to gender-confirming medical procedures is stratified, based on the ability and opportunity to adopt a charge-taking role and on economic and geographic conditions. Based on the results and discussion, we conclude that trans-specific care ought to focus on supporting the care-seekers throughout the medical process, instead of the current focus on verifying the need for care. There is also a need for increased knowledge and financial resources. A separation between legal and medical gender reassignment could contribute to a better relationship between care-providers and care-users and increase the quality of care.

CONCLUSIONS: The Quality and Outcomes Framework (QOF) has been efficiently and effectively incorporated into practice routines. One possible negative effect of this has been a move towards a more biomedical form of practice.There has been patchy but real engagement with practice-based commissioning (PBC), with significant moves in some areas towards GPs acting collectively to improve services across the health economy, including engaging in performance management of each others\' practice.Together, responses to QOF and PBC suggest that GPs may be willing and able to act both individually and collectively to try to mitigate the negative impacts of future spending reductions.
UNASSIGNED: General practice will be under a great deal of pressure in the next few years. Understanding the impact of past policy changes is essential if we are to ensure that the core values of general practice are maintained.