Stefan Timmermans

We argue for a sociology of health, illness, and disease. Under the influence of Talcott Parsons, the social study of health began as medical sociology and then morphed into sociology of health and illness, focusing largely on the social aspects of health-related topics. Social scientists have been reluctant to tackle disease in its physiological and biological manifestations. The result is an impoverishment of sociological analysis on at least three levels: social scientists have rarely made diseases central to their inquiries; they have been reluctant to include clinical endpoints in their analysis; and they have largely bracketed the normative purpose of health interventions. Consequently, social scientists tend to ignore what often matters most to patients and health care providers, and the social processes social scientists describe remain clinically unanchored. A sociology of disease explores the dialectic between social life and disease; aiming to examine whether and how soci...

Genital surgery in children with ambiguous or atypical genitalia has been marred by controversies about the appropriateness and timing of surgery, generating clinical uncertainty about decision making. Since 2006, medical experts and patient advocates have argued for putting the child's needs central as patient-centered care. Based on audio recordings of 31 parent-clinician interactions in three clinics of disorders of sex development, we analyze how parents and clinicians decide on genital surgery. We find that clinicians and parents aim for parent-centered rather than infant-centered care. Parents receive ambivalent messages about surgery: while clinicians express caution, they also present the surgery as beneficial. We examine how parents and clinicians reach agreement about surgery-differentiating parents who push strongly for surgery from parents who do not express any preconceived preferences about surgery and parents who resist surgery. We conclude that clinicians use cli...

This study examines the interface between newborn screening and prenatal diagnosis from the point-of-view of parents of screen-positive children. Many conditions covered by newborn screening represent classic (autosomal recessive) Mendelian disorders. Parents of screen-positive infants therefore often come to learn that they are carriers of the disease, and face a decision whether to test for it in future pregnancies. Semi-structured interviews were conducted in 2015-2017 with 34 Israeli parents whose child was screen positive. Three major themes emanated from the parents' attitudes toward prenatal testing for the disease in prospective hypothetical pregnancies: rejection of prenatal testing for the disease associated with the screen positive, and relying instead on newborn screening to reveal if a future baby is also sick (18/34, 53%); support of prenatal testing to get more information (7/34, 21%) and support of prenatal testing in order to abort in case of a test positive (9/...

... Akrich, “The De-scription of Technical Objects,” in Shaping Technology— Building Society: Studies in Sociotechnical Change, ed. Wiebe E. Bijker ... Mickey Eisenberg et al., “Survival Rates from Out-of-Hospital Cardiac Arrest: Rec-ommendations for Uniform Definitions and Data ...

According to the WHO's Wilson-Junger criteria formulated in the early sixties, public health researchers should justify the decision to screen large populations for rare conditions with their understanding of the nature of a disease, the importance of a disease, the availability of treatment and ...

Complementing discourse-analytic approaches, we develop C. S. Peirce’s semiotic theory to analyze how racism is enacted and countered in everyday interactions. We examine how the semiotic structure of racist encounters depends on acts of signification that can be deflected and that take shape in the ways actors negotiate interactions in situ. After outlining the semiotic apparatus Peirce pioneered, we trace the dynamic processes of generalization and specification in recorded racist encounters as specific forms of semiotic upshifting and downshifting. We demonstrate how attending to racist encounters and engaging the sociology of race sharpen key assumptions that pragmatist semiotics makes about the structure of signification, as it forces one to examine the interplay of marked and unmarked categories and identities in interaction, and to take the differential power to signify into account in shaping the potential effects of semiotic strategies.

We examine what makes urban ethnography unique as a sociological subfield and how to convey this method to aspiring urban ethnographers. As a qualitative research approach, methodological sensibilities about observing, sampling, and data analysis cross boundaries and transcend the urban setting. We suggest a short observational exercise of checking out in a grocery store to stimulate the ethnographic imagination. Next, we turn to three ways to cultivate an ethnographic eye toward the urban: walking the city, paying attention to interactions and institutions, and examining communities and networks. We end with an appeal to engaging with a community of inquiry.

This chapter contains sections titled: Marginal Man, The Concept of a Boundary Object, STS Research Tacks across Disciplinary Boundaries While Tracking Boundary Crossings of Its Subjects, Scientific Work Involves Tracking Work, Tracking Commitments Reflect a Pragmatic Ethical-Epistemic-Ontology, Conclusion, Acknowledgments, Notes, References

Americans raised funds and opened the Broadway Federal Bank in 1947. As a community bank, the goals focused on providing services that mainstream banks were reluctant to offer to better the lives of residents. For example, the bank offered home mortgages to help increase homeownership and student loans to help residents gain an education. Considering the long history of redlining that forced minorities to use predatory home loans with high interest rates and fees, the bank served an important role in the community. Rosas examines how the bank adjusted to changing demographics and worked to survive financially and attract Latino customers, while retaining and not alienating its original African American clientele. As Rosas explains, the bank hired Latinos and in the 1990s, 25 percent of its workers were Latino, including three of the five branch managers, which raised concerns among African Americans. Whereas the bank worked to serve African Americans, to combat the history of neglect and predatory practices of ‘‘mainstream’’ banks, and to transmit this message to African Americans, Rosas points out that it did not try to educate Latinos about its community mission. The failure to do this may have led to the bank’s destruction in 1992. In an oral history, the bank chairman explains that the bank survived the 1965 Watts rebellion but was burned down in the 1992 civil unrest (and rebuilt). He noted that the ‘‘Hispanic population didn’t really get the history of the bank’’ and that ‘‘instead of seeing us as a community bank, they saw us as a federal bank’’ (p. 180). As Rosas points out, the bank could have educated the Latino population about the bank’s community mission. In fact, during her interviews with Mexican immigrants, when she shared the bank’s history, the immigrants responded that this was ‘‘good to know’’ and ‘‘things make sense now’’ (p. 190). Rosas notes that even as the bank focused on the needs of Latinos as clients and hired Latino staff, it overlooked one important area: transferring funds to other countries, a service offered by Bank of America and Wells Fargo. In California, about $10 billion dollars were sent in 2004 to Latin America. Not only did the bank fail to provide this critical service; the bank also missed a major source of profit. There are some areas where Rosas could have provided more information and analysis to better develop her key concept of relational community formation. She describes conflict between the groups, and more could have been said about how the community dealt with these issues, especially from the perspective of African Americans who were seeing a decline in resources. For example, how did the community address funding and hiring for bilingual classes and teachers in the Head Start program? Her portrayal of the bank shows that there was little interaction between the African American and Latino clientele. While this can be a form of accommodation and a way of handling conflict, especially considering the concerns of African Americans over the increasing number of Latinos hired by the bank, Rosas could say more about the overall process of community formation at the bank. While she provides important examples of community formation in particular arenas, such as in the local Head Start councils and among residents, her discussion is less clear about how these different arenas contribute to relational community formation for South Los Angeles as a whole.

Over the past decades, professional medical authority has been transformed due to internal and external pressures, including weakened institutional support and patient-centered care. Today’s patients are more likely to resist treatment recommendations. We examine how patient resistance to treatment recommendations indexes the strength of contemporary professional authority. Using conversation analytic methods, we analyze 39 video recordings of patient-clinician encounters involving pediatric epilepsy patients in which parents resist recommended treatments. We identify three distinct grounds for parental resistance to treatments: preference-, fear-, and experience-based resistance. Clinicians meet these grounds with three corresponding persuasion strategies ranging from pressuring, to coaxing, to accommodating. Rather than giving parents what they want, physicians preserve their professional authority, adjusting responses based on whether the resistance threatens their prerogative to...

Genomic tests such as exome sequencing have recently become an option for diagnosing patients. The tests allow clinical geneticists to sequence the majority of patients' disease causing genetic variants. As a new technology, exome sequencing confronts the question of what the benefit is of this increased genetic information. Against a narrow perspective of clinical utility that emphasises tangible improvements in a patient's disease management, professional organisations have argued that genomic sequencing should be considered beneficial if it helps families and society. Based on video-recorded observations of the return of exome sequencing results to parents of a child with disabilities in the clinic and in-depth interviews with these parents, we examine how genomic test results become actionable in the clinical encounter. We find that parents and clinicians marshal exome results beyond biomedical diagnostic and management goals to address questions about guilt for causing ...

The lack of health insurance is traditionally considered a problem faced by individuals and their families. However, because of the geographically bounded organization and funding of healthcare in the United States, levels of uninsurance in a community may affect everyone living there. Health economists have examined how the effects of uninsurance spillover from the uninsured to the insured, negatively affecting healthcare access and quality for the insured. We extend research on uninsurance into the domain of sociologists by theorizing how uninsurance might exacerbate social inequalities and undermine social cohesion within communities. Using data from the Los Angeles Family and Neighborhood Survey, we show that individuals living in communities with higher levels of uninsurance report lower social cohesion net of other individual and neighborhood factors and discuss implications for implementation of the Affordable Care Act.

Due to heritability, next-generation genetic tests have the potential to affect family members beyond the patient being tested. Geneticists and genetic counselors, in dialogue with patients and their relatives, will need to establish for whom and in what way genomic testing results matter during the communication of testing results, indicating the spillover of presumed pathological variants. On the basis of video-recorded consultations of the return of exome results in a genetics clinic, we distinguish three different logics deployed to explain the relevance of the findings for the patient, extended family members, and unborn relatives. While geneticists tend to be cautious in interpreting findings for the patient and living relatives, the findings become more deterministic in the context of reproductive decision making. The presentation of results then establishes the causal role of variants and reflects back on disability as a state to be prevented, in the process establishing gen...

A B S T R A C T ■ Sociological ethnography largely draws upon two epistemologically competing perspectives — grounded theory and the extended case method — with a different conceptualization of sociological case-construction and theory. We argue that the sociological case in the extended case method is foremost a form of theoretical framing: relying on theoretical narratives to delineate the boundaries of an empirical field. Grounded theory follows the tenets of Chicago School ethnography where the sociological case is elicited from ethno-narratives of actors in the field: the institutionally and interactionally delimited ways members in the field ‘case’ their action. This difference in sociological casing, in turn, is reflected in the ways theory is used. Where the extended case method uses theoretical narratives as a denouement of the case, grounded theory employs theory to construct a grammar of social life.

Social scientists have argued that disease categories are always simultaneously biological and social entities open to negotiation interpretation and contestation. The rise of genetic science promised to provide a stronger bedrock of human biology but the last decades have shown ...

Feminist and disability scholars have critiqued the role of prenatal testing technologies in fostering parental expectations to give birth to “perfect” children. However, in the case of postnatal screening for genetic disorders, identifying large numbers of asymptomatic infants brings previously hidden imperfections into critical relief. Consequently, newborn screening technologies have altered the day-to-day landscape of early childrearing and development for many families. Drawing on ethnographic fieldwork in a California pediatric genetics clinic, we describe how newborn screening creates ambiguous forms of biogenetic abnormality, foreshadowing a life of incipient disorder for children, families, and health care providers and so destabilizing parents' hopes of having a healthy child. By demonstrating key points of convergence and divergence between the social consequences of prenatal and postnatal screening, we expand the analytic gaze on reproductive technologies and establish newborn screening as a vibrant locus of inquiry for the anthropology of reproduction.

Drawing from a critical sociology of knowledge perspective, we situate the production of genetic information within relevant political, financial, and professional contexts. We consider as well the broad range of social conditions that render genetic knowledge salient in clinical settings and for population health. This sociological analysis of genetic knowledge highlights how genetic knowledge flourishes and shapes social environments and how in turn environments select for particular forms of genetic knowledge. We examine the role of the laboratory, regulatory state, and social movements in the production of genetic knowledge and the clinic, family, and population health as critical sites where genetic knowledge becomes actionable.