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This article conveys how taking patient knowledge seriously can improve patient experience and further medical science. In clinical contexts related to infection-associated chronic conditions and other complex chronic illnesses, patient knowledge is often undervalued, even when clinicians have limited training in diagnosing and treating a particular condition. Despite growing acknowledgement of the importance of patients as 'stakeholders', clinicians and medical researchers have yet to fully develop ways to evaluate and, when appropriate, meaningfully incorporate patient knowledge-experiential, scientific, social scientific, historical or otherwise-into clinical practice and research. We argue that there are opportunities for clinicians and researchers to collaborate with patients and colleagues from the social sciences and humanities. We use two examples to demonstrate why patient knowledge should inform medical engagement with chronic and complex conditions. The first comes from a disability studies scholar who describes the social biases that can sideline patient expertise, and the second is from an anthropologist whose reading in medical humanities led to an effective treatment for her recovery. Rather than merely acknowledging 'lived experience', clinical and research teams should include patients with complex chronic conditions as 'knowledge partners'. These patients occupy unique and valuable epistemological positions, and their knowledge should be considered with as much openness and rigour as other forms of medical knowledge. As more medical schools, residency programmes and hospitals emphasise the need for 'deep listening' and patient input, we encourage meaningful engagement with patients whose insights can provide crucial knowledge for clinical and scientific advancement., Competing Interests: Competing interests: EM receives a stipend from Elsevier for her work as Editor in Chief of SSM-Mental Health., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

In 2013, Hans Jörg Rheinberger proposed that Mendelian genetics and molecular biology were "scientific ideologies," that is, for him they are systems of thought whose objects are hyperbolic; they are not, or not yet, in the realm of and not, or not yet, under the control of that system. This article proposes that precision medicine today is a scientific ideology and analyses the implications of this statement for historians of biology, genetics, and medicine., (© 2022 The Authors. Berichte zur Wissenschaftsgeschichte published by Wiley-VCH GmbH.)

Non-invasive prenatal testing (NIPT) is grounded in the analysis of free circulating fetal DNA (cfDNA) in pregnant women's blood. The rolling out of this screening method was in large part driven by commercial firms, which hoped to reach a huge potential market by offering a test that was expected to be risk-free, reliable, inexpensive, and able to detect a wide range of genetic traits of the future child. To date, most predictions about the scope and uses of NIPT have not materialized: in 2020 NIPT detects only a limited number of genetic anomalies, while results have to be confirmed by amniocentesis. NIPT has become a commercial success. Nevertheless the implementation of NIPT has tended to diverge across different national settings. In countries that already have state-sponsored screening for Down risk, NIPT has been offered by the state health insurance to women defined as "high risk", using a variant of the test that detects only three autosomal aneuploidies: trisomy 21, 13 and 18. These countries effectively regulate the supply of NIPT on grounds of cost-effectiveness and reliability. In countries without state-sponsored screening for Down risk, in contrast, multiple versions of NIPT covering a wider range of birth defects are commonly available on the free market, and purchased by women at low as well as high risk of having an affected child. Market-based healthcare systems tend to present women who can afford to pay for NIPT with a largely unregulated choice of technologies - though reimbursement rules imposed by private insurance providers may serve in effect to regulate use by those consumers who cannot afford to pay for tests from their own pockets. This regulatory divergence is shaped by the presence or absence of prior state-sponsored screening programs for Down risk., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

When the Zika virus burst onto the international scene in the second half of 2015, the development of diagnostic tools was seen as an urgent global health priority. Diagnostic capacity was restricted to a small number of reference laboratories, and none of the few available molecular or serological tests had been validated for extensive use in an outbreak setting. In the early weeks of the crisis, key funders stepped in to accelerate research and development efforts, and the WHO took responsibility for steering diagnostic standardization, a role it had successfully played during the West Africa Ebola virus outbreak. Yet when the WHO declared the end of the Zika Public Health Emergency of International Concern in November 2016, diagnostic capacity remained patchy, and few tools were available at the scale required in the countries that bore the brunt of the epidemic, particularly Brazil. This article analyses the limited impact of global R&D efforts on the availability of Zika diagnostic options where they were most needed and for those most vulnerable: women who might have been exposed to the virus during their pregnancy and children born with suspected congenital Zika syndrome. The truncated legacies of testing during the Zika crisis reveal some of the fault lines in the global health enterprise, particularly the limits of 'emergency R&D' to operate in geopolitical contexts that do not conform to the ideal type of a humanitarian crisis, or to tackle technical issues that are inextricably linked to domestic struggles over the scope and distribution of biological citizenship. Diagnostic shortcomings, we argue, lie at the heart of the stunning transformation, in less than two years, in the status of Zika: from international public health emergency to neglected disease.

In the late 1930s, the 17D vaccine against yellow fever was produced in record time. 17D was and is an excellent vaccine. Its rapid diffusion led, however, to several problems, the most important among them being the 1942 massive contamination of the vaccine distributed to the US Army by the hepatitis B virus. The US part of this story is relatively well-known, but its Brazilian part much less so. In 1940, scientists who were producing the 17D vaccine in Rio de Janeiro found that it was contaminated by an "icterus virus" that originated in normal human serum. They solved this problem through the exclusion of human serum from vaccine production, but failed to persuade their US colleagues to do the same. The Rio experts, aware of the potential pitfalls of a new technology, carefully supervised the consequences of their vaccination campaigns. They were thus able to rapidly spot problems and eliminate them. By contrast, US scientists, persuaded of their technical superiority and distrustful of warnings that originated from a "less developed" country, neglected to implement basic public health rules. A major disaster followed. ( Am J Public Health . 2021;111(9): 1654-1660. https://doi.org/10.2105/AJPH.2021.306313).

Since the first recorded case of COVID-19 on February 26, 2020, Brazil has seen an exponential growth in the number of cases and deaths. The national testing approach has been insufficient to correctly use this tool in the support of containing the epidemic in the country. In this communication, we discuss efforts and challenges to scale-up COVID-19 testing at the Brazilian Unified National Health System (SUS). This communication presents the initial results of the research project created to investigate the political, industrial, technological, and regulatory aspects that may affect the diagnostic and testing capacity for COVID-19 in Brazil. The paper draws on the review of academic literature, media publication, and collection of public data on tests purchase and regulation. It enlists initiatives to enhance PCR testing, national production and development of technologies, as well as regulatory measures to fast-track new tests. Our analysis indicates some points of reflection. Firstly, the lack of a consistent national strategy to fight COVID-19 exarcebated supply problems of diagnostic components. If the country was eventually able to circumvent this situation, it still faces a more structural dependency on the importation of diagnostic components. Secondly, the discontinued funding and distribution of tests may have implied health policy fragmentation and the growing importance of local governments and non-state actors to fighting the epidemics within SUS. Finally, initiatives established since the second semester of 2020 have expanded the testing capacity at SUS. However, it has not been sufficient to control the progress of the epidemic in the country.

The claim that anti-malaria drugs, chloroquine and hydroxychloroquine, can cure COVID-19 became a focus of fierce political battles that pitted promoters of these pharmaceuticals, Presidents Bolsonaro and Trump among them, against "medical elites." At the center of these battles are different meanings of effectiveness in medicine, the complex role of randomized clinical trials (RCTs) in proving such effectiveness, the task of medical experts and the state in regulating pharmaceuticals, patients' activism, and the collective production of medical knowledge. This article follows the trajectory of chloroquine and hydroxychloroquine as anti-COVID-19 drugs, focusing on the reception of views of their main scientific promoter, the French infectious disease specialist, Didier Raoult. The surprising career of these drugs, our text proposes, is fundamentally a political event, not in the narrow sense of engaging specific political fractions, but in the much broader sense of the politics of public participation in science., (© 2020 The Authors. Medical Anthropology Quarterly published by Wiley Periodicals LLC on behalf of American Anthropological Association.)

Preimplantation genetic diagnosis (PGD) was developed to allow women/couples at risk of having a child with 'severe and incurable' hereditary disease to produce embryos through in-vitro fertilization, followed by implantation of embryos devoid of mutated genes, allowing the birth of children free of the pathology present in the family. This article examines the highly regulated practice of PGD in France, the highly deregulated practice of PGD in the USA and Brazil, and the extensive use of this biomedical technology in Israel, and highlights the ways that distinct national policies produce distinct definitions of risk and different norms, standards and rules. PGD, this article argues, is a situated practice. Shaped to an important extent by legal and economic constraints, it displays the ways that new technologies continuously reframe our definitions of the normal and the pathological., (© 2020 Published by Elsevier Ltd.)

In the aftermath of the introduction of severe restrictions on abortion in several US states, some activists have argued that providing widespread access to an abortive drug, misoprostol, will transform an induced abortion into a fully private act and therefore will empower women. In Brazil, where abortion is criminalized, the majority of women who wish to terminate an unwanted pregnancy already use the illegal, but easily accessible, misoprostol. We examine the history of misoprostol as an abortifacient in Brazil from the late 1980s until today and the professional debates on the teratogenicity of this drug. The effects of a given pharmaceutical compound, we argue, are always articulated, elicited, and informed within dense networks of sociocultural, economic, legal, and political settings. In a conservative and repressive environment, the use of misoprostol for self-induced abortions, even when supported by formal or informal solidarity networks, is far from being a satisfactory solution to the curbing of women's reproductive rights.

Uncertainty was a defining feature of the Brazilian Zika crisis of 2015-2016. The cluster of cases of neonatal microcephaly detected in the country's northeast in the second half of 2015, and the possibility that a new virus transmitted by Aedes mosquitoes was responsible for this new syndrome, created a deep sense of shock and confusion in Brazil and around the world. When in February 2016 the WHO declared a Public Health Emergency of International Concern (PHEIC), it noted that it did so on the basis of what was not known about the virus and its pathogenic potential. To better understand the role that non-knowledge played in the unfolding of the Brazilian Zika crisis we differentiate between three different kinds of uncertainty: global health uncertainty, public health uncertainty, and clinical uncertainty. While these three forms of uncertainty were difficult to disentangle in the early weeks of the crisis, very soon each one began to trace a distinct trajectory. Global health uncertainty centered on the question of the causative link between Zika virus infection and congenital malformations, and was declared resolved by the time the PHEIC was lifted in November 2016. Public health and clinical uncertainty, in contrast, persisted over a longer period of time and did, in some important ways, become entrenched. This taxonomy of uncertainties allows us to explore the systematic nonproduction of knowledge in times of medical emergency, and suggests structural limitations in the framework of "emergency research" that global health institutions have developed to deal with unexpected threats., (Copyright © 2020. Published by Elsevier Ltd.)

The conceptual and practical work done by social medicine and global health have often overlapped. In this paper, we argue that new efforts to apprehend 'the social' in social medicine offer important insights to global health along five lines of critical analysis: (1) reconfigurations of the state and new forms of political activism, (2) philanthrocapitalism and the economisation of life, (3) The economy of attention, (4) anthropogenic climate change, and (5) the geopolitics of North and South.

This article examines the origins of the term "genetic disease." In the late 19 and early 20th century, an earlier idea that diseases that occur in families reflect a vague familiar "predisposition" was replaced by the view that such diseases have specific causes, while Mendelian genetics provided then clues to the patterns of their transmission. The genetictisation of inborn pathologies took a decisive turn with the redefinition, in 1959, of Down syndrome as a chromosomal anomaly, then the development of tests for the diagnosis of other hereditary pathologies. At that time, geneticists distinguished "hereditary" diseases that run in families, from "genetic" conditions that are the result of new mutations during the production of egg and sperm cells. In the latter case, the inborn impairment is produced by an anomaly in the genetic material of the cell, but is not hereditary, because it is not transmitted from one or both parents. In the late 20th and early 21st century, new genomic technologies blurred the distinction between hereditary and genetic impairments, extended the concept of genetic disease, and modified the experience of people living with such a disease.

Within the context of the creation of birthing houses around the world and different models of care for childbirth, the author proposes an analysis that contributes to the discussion about the place for birth, especially in urban Brazil.

Infection with the zika virus had a great impact not only on pregnant women and newborns, but also on public health, on popular ideas about Aedes aegypti and with respect to women's social rights. The objective of this paper is to identify this impact and the historical, social and health changes of the disease and the legacy of the zika virus. Interventions by researchers from different specialties foster conditions for more comprehensive investigations into future epidemic threats in Brazil and Latin America. This dialogue took place after the seminar "Aedes aegypti: past and future health emergencies," organized by the Casa de Oswaldo Cruz, when we talked with some speakers and other leading researchers about the history and challenges of Aedes aegypti and zika.

In 1958, the Pan American Health Organization declared that Brazil had successfully eradicated the mosquito Aedes aegypti, responsible for the transmission of yellow fever, dengue fever, chikungunya, and Zika virus. Yet in 2016 the Brazilian minister of health described the situation of dengue fever as "catastrophic." Discussing the recent epidemic of Zika virus, which amplified the crisis produced by the persistence of dengue fever, Brazil's president declared in January 2016 that "we are in the process of losing the war against the mosquito Aedes aegypti." I discuss the reasons for the failure to contain Aedes in Brazil and the consequences of this failure. A longue durée perspective favors a view of the Zika epidemic that does not present it as a health crisis to be contained with a technical solution alone but as a pathology that has the persistence of deeply entrenched structural problems and vulnerabilities.

Prenatal diagnosis was developed in the 1970s, a result of a partly contingent coming together of three medical innovations-amniocentesis, the study of human chromosomes and obstetrical ultrasound-with a social innovation, the decriminalization of abortion. Initially this diagnostic approach was proposed only to women at high risk of fetal malformations. Later, however, the supervision of the fetus was extended to all pregnant women. The latter step was strongly favoured by professionals' aspiration to prevent the birth of children with Down syndrome, an inborn condition perceived as a source of suffering for families and a burden on public purse. Experts who promoted screening for 'Down risk' assumed that the majority of women who carry a Down fetus will decide to terminate the pregnancy, and will provide a private solution to a public health problem. The generalization of screening for Down risk increased in turn the frequency of diagnoses of other, confirmed or potential fetal pathologies, and of dilemmas linked with such diagnoses. Debates on such dilemmas are usually limited to professionals. The transformation of prenatal diagnosis into a routine medical technology was, to a great extent, an invisible revolution., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Prenatal diagnosis (PND) is frequently identified with genetic testing. The termination of pregnancy for foetal malformation was called 'genetic abortion', in spite of the fact that in many cases the malformation does not result from changes in the genetic material of the cell. This study argues that the 'geneticization' of PND reflected the transformation of the meaning of the term 'genetics' in the 1960s and 70s. Such transformation was linked with the definition of Down syndrome as a genetic condition, and to the key role of search for this condition in the transformation of PND into a routine approach. The identification of PND with the polysemic term 'genetics' was also favoured by hopes that cytogenetic studies will lead to cures or prevention of common birth defects, the association of genetic counsellors with prenatal diagnosis, and the raising prestige of clinical genetics. In spite of the impressive achievements of the latter specialty, more than fifty years after the first prenatal diagnoses, the main 'cure' of a severe foetal malformation remains the same as it was in the 1960s: the termination of a pregnancy. The identification of PND with genetics deflects attention from the gap between scientists' capacity to elucidate the causes of numerous birth defects and their ability (as for now) to prevent or treat these defects, and favours the maintenance of a powerful regimen of hope., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Debates on human experiments in developing countries focus on ethical principles such as informed consent, accountability, involvement of the concerned communities, and the improvement of local health services. Public health specialists who conducted human experiments in Rio de Janeiro (1902-1905) and in Guatemala (1947-1948) believed, however, that they were acting in the best interests of local populations, were aware of the importance of informed consent, were closely collaborating with local health professionals, and were contributing to the development of local health structures. Nevertheless, their investigations went dramatically wrong. An initial desire to conduct ethically and scientifically sound studies was undermined by pressure to obtain results and to save the researchers' initial investment, the possibility of freely using hospitalized patients as experimental participants, uncritical help from local professional elites, and structural pitfalls of experimenting with severely deprived people. These elements can still be found in trials of preventive methods in the Global South.

In 1919, the French pathologist and pioneer of radiotherapy of cancer, Antoine Lacassagne, studied the case of a young man of indeterminate sexuality (a condition later named "intersex," and recently renamed, "disorders of sexual development"). Lacassagne's argument that the patient was a "true" hermaphrodite, that is, an individual who possesses at the same time male and female sexual glands, was grounded exclusively in his study of microscopic preparations. Such preparations were seen as the definitive proof of the "true biological sex" of a given person, seen as a fixed entity. On the other hand, Lacassagne's definition of biological, or rather histological sex, was dissociated from sexuality, sexual orientation and sex/gender identity. In the 1930s, the isolation of sex hormones made it possible to modulate specific sexual traits, thus destabilizing the concept of a fixed biological sex. It did not undermine, however, the central role of histological proofs. Sex on a slide continued to be seen as definitive evidence of the "true" sexual identity of an individual, but from the 1930s this proof was valid only for the time when a given microscopic preparation had been manufactured.

The introduction of new techniques of prenatal diagnosis in the 1960s transformed already back then, and continues to transform, the epistemic space of human heredity. These techniques - like karyotyping, amniocentesis, obstetrical ultrasound, and, more recently, analysis of free foetal DNA in maternal blood - modify the way in which people influence the transmission of traits to their offspring and thus have the potential to define what a "normal," "acceptable," or "valuable" human being is.

After the World War II era, Western experts explained that the progress of medicine, which had led to a decrease in mortality in developing countries ('control of death') was not accompanied by a parallel decrease in birth rates ('control of life'). This conjunction, they warned, would lead inexorably to population explosion and its terrifying consequences: famines, riots, political instability, expansion of Communism, wars. A heterogenous coalition of demographers, public health experts and politicians was urgently looking for an effective means to curb population growth. In the 1950s, many of them considered that mass distribution of foam tablets, a local contraceptive presented as simple to use, cheap and efficient, was a possible solution for the population crisis. At the same time, a potential opening of huge markets for this product generated intense competition among manufacturers and attempts to disqualify competing preparations as inefficient and dangerous for health. Struggles around the marketing of foam tablets, especially in India, reveal a unique combination of science, medicine, cold war politics, philanthropy and business. The presumed commercial and social potential of foam tablets was never fulfilled, due to the unreliability both of the product itself and of its 'backward' users, who either refused this contraceptive mean, or abandoned it promptly., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

The birth of the "do not delay" principle in cancer treatment has often been linked with developments in late nineteenth century: the rise of histology and cellular theory of malignancy that favored the definition of cancer as a local pathology, then the development of radical surgical techniques that transformed malignant tumors into a potentially curable condition. This text seeks to nuance this view. It points out important continuities in the understanding of the natural history of uterine cancers. At its center, the wish, already present in early nineteenth century, is to detect "early," that is, small and localized malignant lesions, then to extirpate or destroy these lesions before they become fully blown cancer. The long history of this particular regime of hope helps demonstrate why it is so difficult today to promote more nuanced views of the efficacy of early detection of malignant tumors.

The quasi-totality of social scientists who studied screening for cervical tumours identified such screening with a single method: the Pap smear (exfoliative cytology). This article explains that this method was not valid everywhere. The history of screening for cervical cancer in Brazil displays an alternative method for detecting cervical malignancies: a direct observation of the cervix with a specific instrument--the colposcope. The development of this method in Brazil in the 1940s and 1950s reflected a complex mixture of professional interests, government policies, and regional, local and charitable initiatives. While the use of colposcopy for cervical tumour screening was phased out in the 1970s and 1980s, the long lifespan and widespread diffusion of this method illuminates the irreducible contingency of specific developments in science, technology and medicine. Seen from the vantage point of Brazil, the Western model for preventing cervical malignancies no longer appears self-evident Alternative choices might have led to the development of different material and visual cultures of medicine, stimulated different patterns of medical specialization and division of medical labour, produced different links between malignancies, women, gynaecologists, epidemiologists and public health experts, and shaped different health policies.

The history of contraceptives met the history of drugs long before the invention of the contraceptive pill. In the first half of the twentieth century, numerous pharmaceutical laboratories, including major ones, manufactured and marketed chemical contraceptives: jellies, suppositories, creams, powders and foams applied locally to prevent conception. Efforts to put an end to the marginal status of these products and to transform them into 'ethical' drugs played an important role in the development of standardized laboratory tests of efficacy of contraceptive preparations; debates on the validity of such tests; evaluation of the long-term toxicity of chemical compounds; and the rise of collaborations between activists, non-profit organizations and the pharmaceutical industry. Chemical contraceptives were initially associated with quack medicine, shady commercial practices and doubtful morality. Striving to change the status of contraceptives and to promote safe and efficient products that reduced fertility in humans shaped some of the key features of the present-day production and regulation of pharmaceuticals.

History of biomedicine is a hybrid domain, intersecting with many other scholarly disciplines. From the 1970s, historians who investigated recent developments in medicine increasingly shared the approaches, presuppositions, and methods of inquiry of historians and sociologists of science and technology. One reason is that the increasing reliance of medicine on technologies, instruments, and drugs makes the demarcation between "medicine," "science," and "industry" more difficult. Another is the "practice turn" in the history of science, which gave greater attention to the ways scientists and physicians work. The impressive achievements of historians who applied these new approaches came, however, at a cost. The neglect of an earlier generation of historians of medicine may have limited more recent ambitions for understanding health and disease in society. Closer links with historians of science and technology and sociologists of science may have blurred the specificity of medicine as a domain grounded in the distinction between the normal and the pathological and lessened scholars' interest in "the clinic" as a unique site of the production of knowledge.

Iconic accounts of the "bacteriological revolution" presented it as a radical change in the understanding of the natural world. Scientist had discovered that human being shared their environment with billions of invisible living beings which shape life phenomena, health and disease. They also learned to cultivate and manipulate these invisible creatures. The domestication of microorganisms in the laboratory disarmed them as enemies and occasionally transformed them into allies. This analysis of the development in French bacteriology displays a more nuanced and complex picture, with continuities as well as ruptures, and multiple levels of change. Between 1880 and 1900, the rise of "pasteurian science" did produce important changes in French society, but these changes were obtained through a variety of approaches: introduction of new experimental techniques, administrative and legal methods, training of professionals, education of the general public, and a direct political intervention.

This paper follows the history of "morphological risk" of breast cancer. In the early twentieth century, surgeons and pathologists arrived at the conclusion that specific anatomical and cytological changes in the breast are related to a heightened risk of developing a malignancy in the future. This conclusion was directly related to a shift from macroscopic to microscopic diagnosis of malignancies, and to the integration of the frozen section into routine surgery for breast cancer. In the interwar era, conditions such as "chronic mastitis" and "cystic disease of the breast" were defined as precancerous, and women diagnosed with these conditions were advised to undergo mastectomy. In the post-World War II era, these entities were replaced by "carcinoma in situ." The recent development of tests for hereditary predisposition to breast cancer is a continuation of attempts to detect an "embodied risk" of cancer and to eliminate this risk by cutting it out.

In the inter-war period physicians elaborated numerous 'biotherapies' grounded in the complex interactions between physiology, bacteriology and immunology. The elaboration of these non-specific biological treatments was stimulated by the theory of generalized anaphylaxis that linked the violent reaction to a foreign protein to a broad array of chronic diseases, from asthma and urticaria to rheumatism or chronic colitis. Such diseases were perceived as the result of an 'abnormal reactivity' to a sensitisation of tissues and organs by bacteria and by foreign proteins, a view that provided an effective bridge between new concepts derived from bacteriology and immunology and the long-standing pathological tradition. Accordingly, physicians attempted to treat these conditions through specific desensitisation and non-specific biological therapies: peptone treatment, protein therapy, haemotherapy, 'antivirus' or 'opotherapy'. Therapies that attempted to neutralise the harmful effects of chronic infections through 'desensitisation' were not seen as marginal medical practices, but were promoted by leading advocates of the 'Pasteurian sciences', such as Richet, Widal, Vallery-Radot, Wright and Fleming. They also led to development of new products by the pharmaceutical industry.

Routine acceptance of use of hormone replacement therapy (HRT) was shattered in 2002 when results of the largest HRT randomised clinical trial, the women's health initiative, indicated that long term use of oestrogen plus progestin HRT not only was associated with increased risk of cancer but, contrary to expectations, did not decrease, and may have increased, risk of cardiovascular disease. In June 2004 a group of historians, epidemiologists, biologists, clinicians, and women's health advocates met to discuss the scientific and social context of and response to these findings. It was found that understanding the evolving and contending knowledge on hormones and health requires: (1) considering its societal context, including the impact of the pharmaceutical industry, the biomedical emphasis on individualised risk and preventive medicine, and the gendering of hormones; and (2) asking why, for four decades, since the mid-1960s, were millions of women prescribed powerful pharmacological agents already demonstrated, three decades earlier, to be carcinogenic? Answering this question requires engaging with core issues of accountability, complexity, fear of mortality, and the conduct of socially responsible science.

Western medicine is seen as universally valid, but in reality it displays a wide range of national and local variability. Our paper focuses on one such case of local variation: the widespread use of progestins in France to treat various pre-menopausal conditions as well as for contraception. The case of progestins allows us to explore how specific styles of research may come to dominate a particular local medical culture, and how they are influenced by changing criteria of scientific validity and wider social relations. We argue that in the 1980s and 1990s a single prestigious research-oriented Parisian hospital service played a dominant role in the transformation of progestins into scientifically validated medical practice. This status was not called seriously into question until recently when foreign research on a different form of hormone therapy suggested that risk was associated with their use. We also propose that both the research around and medical use of progestins in France was shaped by the positive attitude of many French women, including feminists, to hormonal therapies and to the non-surgical specialty most closely associated with hormones, medical gynaecology.

This paper compares anti-hookworm campaigns conducted in the early twentieth century in France, Germany, Brazil and West India. The populations that suffer from hookworm are not identical in the North and in the South. In tropical and semi-tropical regions hookworm is mainly found among poor peasants and is related to lack of hygiene, while in temperate climates hookworm was a professional disease of miners, a highly organized professional segment. Nevertheless, major disparities in the pattern of hookworm control did not reflect the North-South divide, but a difference between campaigns. These aimed at the eradication of hookworm infection (Germany and West-India) and at alleviating the effects of this infection on populations (France and Brazil). Maps that represented the prevalence of hookworm mirrored the aims of the sanitary campaign in which they were used: eradication of parasitic worms versus the reduction of the handicap induced by these worms. In public health as well, representing is intervening. And vice versa: patterns of intervention shape representations.