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This is a pre-print of an article published in BioSocieties. The definitive publisher-authenticated version Sweet, P. L. and Decoteau, C. L. Contesting normal: The DSM-5 and psychiatric subjectivation. Biosocieties. 2018. 13(1): 103-122. 10.1057/s41292-017-0056-1 is available online at: 10.1057/s41292-017-0056-1.

This article discusses birth defect intervention and genetic services as measures of intervention in China. Based on the practical application of a three-level intervention model, it analyses the important roles played by genetic services in the areas of premarital, pregestational and prenatal genetic screening, genetic counselling, and testing in the prevention of birth defects in China. It demonstrates that since there is imbalanced development in different areas of China, genetic services are underutilised. In practice, the intervention model has problems and is facing difficulties and challenges. And, given the national desire to reduce birth defects, nondirectiveness is not getting the attention deserved in genetic counselling. An insufficiency of psychological support and humanistic care in genetic services, and lack of social and financial support for the children with birth defects and their families still exists widely in China.

This article compares the treatment of living beings (unvaccinated chickens and infected cells) considered as sentinel devices in a farm and in a lab in Hong Kong. Sentinel devices are defined as living beings posted on a boundary from which they send signals of invisible threats. The ethnography looks at how they transform differences between ordinary lives and lives exposed, between good death and bad death, through the practices of those who feed them. In farms and labs exposed to Avian Influenza viruses, the logic of biosecurity intersects with a logic of care, blurring the distinction between self and other, friend and enemy through aesthetic judgments concerning what is a ‘good death’. Metabolism and immunity are redefined when sentinels are fed to produce clear signals of the mutations of viruses.

This special issue of Culture, Medicine, and Psychiatry presents six papers along the theme of ‘‘Conceptualizing Autism around the Globe.’’ This collective has several important precursors, including a special issue in Ethos (Solomon and Bagatell 2010) and another in BioSocieties (Eyal et al. 2014), as well as Davidson and Orsini’s (2013) Worlds of Autism. Indeed, a self-conscious anthropology of autism is emerging. In a book review, a year ago (Cascio 2014), I identify the following characteristics of this emergent field: ‘‘(1) A holistic view that considers the place of autism in the larger sociocultural context. (2) Attention to the local and historical particularity of the concept of autism. (3) Attention to the lived experience of people with autism and those close to them’’ (Cascio 2014:307). Previous reviews have identified similar characteristics and themes in the social study of autism. Solomon’s (2010) review of autism and the anthropology of the senses identifies three major contributions of anthropology to the study of autism

The accidental discovery of smallpox vials at the National Institutes of Health earlier this year quickly attracted the attention of the health and security communities. Smallpox was officially eradicated decades ago, and is only supposed to exist in two carefully guarded labs – and the National Institutes of Health isn’t one of them! This interview focuses on a biotech company that has spent the last 10 years developing a vaccine against what has so far been a non-existent disease. It discusses possible avenues for the re-emergence of smallpox, including the impact of developments in synthetic biology, and it gives an inside view on the biodefence industry and its unusual business model.

The papers collected in this special issue examine specific instances of autism research, treatment and advocacy. Their shared aim is to explore not the causes, but the manifold biosocial consequences and theoretical implications of the recent expansion of the autism spectrum. Three such implications are singled out in the introduction as common threads running through all the papers. First, the extent to which developments in the field of autism research, treatment and advocacy pose a challenge to theories of ‘biomedicalization’ and ‘geneticization’. Second, the intimate connection between autism’s recalcitrance to be pinned down and explained and its enormous biosocial productivity. Third, the need to broaden Hacking’s (1998, 2006) concept of ‘looping’ to make sense of the ‘moving target’ that is autism.

Autism has become a ‘biomedical platform’ for sex differences research in fields such as genetics, endocrinology and neuroscience. Increasingly, researchers in these fields pose the male prevalence of autism as a model for investigating sex differences in the brain, and offer basic research on sex differences in the brain as a resource for understanding the etiology of autism. The use of autism as a biomedical platform for sex differences research obscures empirical and interpretive contestations surrounding claims about the male prevalence of autism. We argue that the uncritical use of this research platform across many fields stands to distort scientific research on autism and contribute to harmful gender stereotypes.

The sociology of expectations has examined ways in which future expectations shape how technological options are selected and stabilised. Personal genomic susceptibility testing (PGST) is introduced as an example of a technology where expectations serve a crucial role, thanks to the inherently future-oriented nature of testing for genetic susceptibility to future health conditions. Nonetheless, expectations may increase rather than decrease scientific, regulatory and commercial uncertainties surrounding a technology. Technology promoters may therefore enact particular strategies to prove that technologies are not in need of stringent, technology-specific regulation. With the aid of an extensive historical analysis of company websites, together with semi-structured interviews with company representatives, it is shown how four PGST companies based in the United States have used efforts towards collaborative standardisation as ways of stabilising and legitimating PGST in an often hostile environment. We explore how these strategies make use of expectations, and how they centre on the promotion of new ‘regulatory objects’ in an effort to influence regulatory agendas. Although processes of standardisation in the PGST industry have stalled, we suggest that they nonetheless represent successful engagement with regulators, insofar as they have succeeded in shaping regulatory agendas and staving off new regulation.

It is widely claimed that research to discover and develop new pharmaceuticals entails high costs and high risks. High research and development (R&D) costs influence many decisions and policy discussions about how to reduce global health disparities, how much companies can afford to discount prices for lower- and middle-income countries, and how to design innovative incentives to advance research on diseases of the poor. High estimated costs also affect strategies for getting new medicines to the world's poor, such as the advanced market commitment, which built high estimates into its inflated size and prices. This article takes apart the most detailed and authoritative study of R&D costs in order to show how high estimates have been constructed by industry-supported economists, and to show how much lower actual costs may be. Besides serving as an object lesson in the construction of ‘facts’, this analysis provides reason to believe that R&D costs need not be such an insuperable obstacle to the development of better medicines. The deeper problem is that current incentives reward companies to develop mainly new medicines of little advantage and compete for market share at high prices, rather than to develop clinically superior medicines with public funding so that prices could be much lower and risks to companies lower as well.