This project investigates the origins, meanings, and effects of new medical pharmaceuticals that can both treat disease and address the functioning of healthy individuals. Using interviews with biomedical professionals who deploy these new pharmaceuticals, and ethnographic observations, this research examines how the development and use of these pharmaceuticals are understood by biomedical professionals, who have historically been oriented toward assisting those who are ill rather than addressing biomedical issues in healthy people. Interviews and ethnographic research are also used to investigate how users learn about and attribute value to these new pharmaceuticals.
This research contributes to social science theories of how human health and well-being are understood and evaluated by biomedical professional and scientists. It also contributes to social science theories of the sources of change in biomedical practices, by examining the role of new products in shaping assumptions, subjects, and personnel.
Broader impacts of this research include new resources for programs intended to provide public information about new pharmaceuticals, and materials that can help in the formulation of policy responses and professional guidelines for biomedical professionals whose practices may be shaped by new orientations toward human well-being.
In the past two decades, there have been increasing numbers reports of cases in which healthy individuals have used prescription medications to improve their performance. This issue emerged because of new drugs were discovered, which were believed to have effects on both sick and healthy individuals. The most commonly cited population of individuals using these kinds of medications are college and high school students who use prescription stimulants to study. This practice of self-improvement through prescription medications is known as "enhancement" in the academic literature. Most research that has been conducted to date is either quantitative, in that is examines the public health aspects of this issue, or makes theoretical, bioethical arguments about the ethics of enhancement. This NSF funded research took an empirical, ethnographic approach. This entailed collecting data through interviews with stakeholders like: users of enhancement medications; physicians, scientists, journalists, politicians, teachers, and others studying this issue; and observation in settings like clinics or conferences were enhancements were discussed. The research was conducted in Germany, where there has been an ongoing public debate about enhancements. Major findings of the research include the following: an important ethical issue that users and other stakeholders raise, which is often not discussed in the academic literature, concerns how these drugs are not an ‘improvement’ as much as they are a sign that individuals are being asked to meet ‘excessively’ high demands for productivity or performance at work or school. This aspect is a source of much of the resistance to enhancements in Germany. Another major finding was to provide ethnographic evidence that the distinction between ‘enhancement’, and medical ‘treatment’ is not as clear cut as is sometimes assumed in the literature. This line can be difficult to draw because conditions that were formerly not viewed as diseases can come to be ‘in need of treatment’ over time. Typically, the shift from ‘no treatment required’ to ‘treatment recommended’ is driven by data from clinical trials. By describing user and stakeholder perspectives on enhancement, this research produced empirical data about an important emerging issue. It also provided a case study of a more general process in contemporary societies, about how prescription pharmaceuticals are being used for new conditions and to create lifestyles.
