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Public reporting of clinical performance is increasingly used in many countries to improve quality and enhance accountability of the health system. The assumption is that greater transparency will stimulate improvements by clinicians in response to peer pressure, patient choice or competition. The international diffusion of public reporting might suggest greater similarity between health systems. Alternatively, national and local contexts (including health system imperatives, professional power and organisational culture) might continue to shape its form and impact, implying continued divergence. The paper considers public reporting in the USA and England through the lens of Scott's ‘pillars’ institutional framework. The USA was arguably the first country to adopt public reporting systematically in the late 1980s. England is a more recent adopter; it is now being widely adopted through the National Health Service (NHS). Drawing on qualitative data from California and England, this paper compares the behavioural and policy responses to public reporting by health system stakeholders at micro, meso and macro levels and through the intersection of ideas, interests, institutions and individuals through. The interplay between the regulative, normative and cultural-cognitive pillars helps explain the observed patterns of on-going divergence.

© 2017, © 2017 Informa UK Limited, trading as Taylor & Francis Group. The potential for harms from adverse drug reactions (ADR) constitutes a critical patient safety and public health challenge, especially with increased medication usage as populations age. The research reported here explores explanations for a sudden increase in ADR reporting in New Zealand after a new formulation of a medication to treat hypothyroidism, Eltroxin® (levothyroxine), was phased in. The formulation was adjudged to be bioequivalent to the old formulation, yet following its introduction, a sharp increase in the reporting of adverse reactions to this drug occurred. The paper analyses public engagement and the role of print media coverage, press releases and minutes of meetings of relevant agencies in order to describe the unfolding of this health controversy. Early interpretations of the sharp increase in reporting of reactions explained it as an outcome of a combination of factors, including a mistrust of state drug subsidising agencies and media attention that provoked anxiety in this vulnerable population. This paper offers an alternative explanation arguing that, as adverse drug reactions are known to be significantly underreported, the Eltroxin® ‘health scare’ illustrates enhanced pharmacovigilance triggered by the interaction between patients and the media. The Eltroxin® controversy is an illustrative case example of the amplification of ADR reporting by patients following increased media attention in the context of a low consumer reporting environment. The case of Eltroxin® indicates that drug safety can be enhanced by actively using media sources and by encouraging patient engagement and reporting of ADRs.

This article uses a socio-material approach, social practice theory, to provide new insights into the self-management of chronic illness. It demonstrates how this theory can bridge arguments about the respective roles of social and individual influences, and how it can foreground an oft-overlooked aspect of the issue - the demands of self-care technologies and consequences for participation in social life. Drawing on interviews and focus groups with 25 young type-1 diabetes outpatients in London, UK, the study points to the conflicts that occur when disease management technologies compete for time and space with the social practices of everyday life, and when self-care tasks threaten to interrupt the flow of social life and make people feel 'left behind'. The paper concludes that young people are disabled by the contingent position of self-care activities in daily life, which oblige them to compromise either their physical health or their immersion in the social world. This disabling effect would be mitigated if social practices were reorganised to make them more amenable to the time-space requirements of disease management. A social practice theory lens can help throw light onto this issue and make a valuable contribution to the study of the self-management of chronic illness.

Sleep, until recently, has been a neglected topic or issue within sociology and the social sciences and humanities in general. At first glance this may seem unsurprising given the predominant waking assumptions, concerns or preoccupations of these disciplines. Further reflection, however, reveals the shortcomings of any such neglect or dismissal of sleep as a topic worthy of sociological attention. Sleep is a socially, culturally and historically variable phenomenon. How we sleep, when we sleep, where we sleep, what meaning and value we accord sleep, let alone with whom we sleep, are all important topics of sociological investigation which do not simply vary around the world, both past and present, but within different segments of society and within and between cultures. The nature, quantity and quality of sleep, moreover, is clearly important both for the individual and society in terms of health and safety, productivity and performance, quality of life and well-being. In part a response to this past neglect, and in part a response to broader social trends and transformations regarding sleep, sociologists and others in the social sciences and humanities are now turning their attention to what might broadly be termed the ‘sleep and society’ agenda (Williams 2005; Williams 2008). Sleep, in this respect, is not simply a rich and fascinating sociological topic in its own right, but a valuable new window or way of approaching a range of existing sociological research agendas on issues as diverse as work, health, gender, ageing and family life. This work in turn opens up significant new opportunities to explore the dynamic interrelations between social and biological factors regarding sleep and sleep disruption across the life course. In these and many other ways then, a sociological approach to sleep is not simply long overdue, but a timely and valuable complement to work in related fields of inquiry such as sleep epidemiology and public health which, in similar fashion, take us far beyond the sleep laboratory or sleep clinic to broader issues concerning sleep, health and society. It is therefore to a further consideration and elaboration of this newly emerging sleep and society agenda within sociology that we now turn in this chapter. We outline several strands of recent sociological work - starting with some preliminary points regarding the very conceptualisation and measurement of ‘sleep’ as a methodological backdrop to the sociological themes and issues that follow.

Much research on chronic illness, which views the experience as disruptive, is adult-focused though there is an emerging literature on children's and young people's experiences. Drawing on 31 interviews conducted with young people diagnosed with asthma in south-west Ireland, this article contributes to this literature. The sample includes boys (n = 15) and girls (n = 16) aged between 5 and 17 from the Irish Traveller community and the larger settled community. The study also explores the potential value of what might be called biographical contingency. This concept refers to the way in which a chronic illness may be an 'only sometimes' problem and takes account of the 'now you see it, now you don't' nature of a condition that varies in terms of its symptoms, meanings and consequences. In concluding, we consider the uses and limitations of this concept and the interpretivist paradigm that typically informs qualitative research on the illness experience.

Joan Busfield’s (2017) reassessment of the concept of medicalisation is a welcome and timely contribution to a key issue within medical sociology, past and present. Not simply medical sociology however. Medicalisation indeed, as Conrad (2015) himself notes, now carries ‘analytical weight’ in a range of disciplines beyond sociology including history, anthropology, bioethics, economics, media studies and feminism. To this of course we may add engagements within medicine itself as well as the wider circulation of ‘medicalisation’ within popular culture if not public consciousness today as a commonly used if not abused term of reference, thereby rending medicalisation a victim of its own success perhaps. Hence debates in recent years as to whether or not medicalisation has outlived its usefulness as a concept, including its relationship to other newly developed concepts and ways of theorising these matters, in sociology and beyond (Bell & Figert, 2015a,b, 2014; Rose, 2007).

We aimed to gain an in-depth understanding of public views and ways of talking about antibiotics. Four focus groups were held with members of the public. In addition, 39 households were recruited and interviews, diaries of medicine taking, diaries of any contact with medication were used to explore understanding and use of medication. Discussions related to antibiotics were identified and analyzed. Participants in this study were worried about adverse effects of antibiotics, particularly for recurrent infections. Some were concerned that antibiotics upset the body’s “balance”, and many used strategies to try to prevent and treat infections without antibiotics. They rarely used military metaphors about infection (e.g., describing bacteria as invading armies) but instead spoke of clearing infections. They had little understanding of the concept of antibiotic resistance but they thought that over-using antibiotics was unwise because it would reduce their future effectiveness. Previous studies tend to focus on problems such as lack of knowledge, or belief in the curative powers of antibiotics for viral illness, and neglect the concerns that people have about antibiotics, and the fact that many people try to avoid them. We suggest that these concerns about antibiotics form a resource for educating patients, for health promotion and social marketing strategies.

The 2012 Health and Social Care Act, introduced by the coalition government, has been seen as fundamentally changing the form and content of publicly funded health care provision in England. The legislation was hugely controversial and widely criticized. Much of this criticism pointed to the ways in which the reforms undermined the funding of the National Health Service, and challenged the founding principle of free universal provision. In this commentary we take issue with the argument that the Act represented a radical break with the past and instead suggest that it was an extension of the previous Labour government’s neo-liberal reforms of the public sector. In particular, the Act invoked the principles of ‘new professionalism’ to undermine professional dominance, and attract private providers into statutory health care at the expense of public providers. In turn, this extension of new professionalism may encourage public distrust in the medical profession and absolve the state of much of its statutory health care obligation.

Seeking Research Ethics Committee (REC) approval in the humanities and social sciences (HSS) is increasingly encumbered by bureaucratic rules and regulations. Termed ‘ethics creep’, such governance is challenged by an emerging body of international literature. This article contributes to such literature by documenting the emotional vicissitudes of seeking REC approval in an Irish university, for a proposed sociological study of children with asthma. Our critical discussion includes an account of indeterminate bureaucratic procedures and protocol which, despite their formally rational and rationalised status, were unreasonable, insidious and frustrating. Challenging ‘ethics creep’ and promoting critical debate underpins our discussion of the researcher’s experiences and responses when confronted with bureaucratic irrationality – arguably something that not only taxes researchers’ emotions and commitment but also threatens to ‘strangle’ HSS research and the research base more generally.

This article draws on fieldwork conducted with nurses in two sites of NHS Direct, the English tele-nursing service.Theoretically it has two objectives. Firstly to examine a group of professional workers in order to show how the discourse of work transformation associated with the call centre paradigm interacts in a non-mass, non-commercial public sector setting where workers remain attached to their occupational identity and institutional community which mediate call centre values and rationalities. In relation to this objective, the article shows how call centre values inform NHS Direct but do not produce the same outcomes as in commercial settings. Secondly, the article establishes that nurses, as knowledgeable actors, can control, manipulate and create knowledge, without having their autonomy subordinated to the clinical software they are required to use.The article contributes to the labour process approach of call centre working and debates on knowledge management in the workplace.

This paper explores the interpretive negotiation of professional values by nurses working in a large public-sector organisation in the UK, namely the NHS Direct (NHSD). Reported are findings from a number of case studies of NHSD, undertaken in response to calls for more research into so-called professional call centre settings.

In 2012 the UK media reported the results of a paper in the British Medical Journal Open, including the finding that hypnotics increase the risk of ‘premature death’. Taking this media coverage as a case study, the paper explores UK people's responses and assesses the implications for the debate about the (de)pharmaceuticalisation of sleep. Two hundred and fifty one posts to the websites of 6 UK newspapers were analysed thematically, along with 12 focus group discussions (n = 51) of newspaper coverage from one UK newspaper. Four thematic responses were identified: bad science/ journalism, Hobson's choice, risk assessment and challenging pharmaceuticalisation. We found that most people claimed that the story did not worry them, even if they stated that they were using sleeping pills, and that focus group members generally appeared to respond in terms of their pre-existing views of hypnotics. The way in which lay expertise was drawn on in responding to the coverage was one of the most striking findings of the study. People referred to their own or others' experience of taking hypnotics to recognise the legitimacy of taking them or to weigh up the risks and benefits, as reflexive users. Overall, our case study cautions against making strong claims about the power of the media to legitimate de-pharmaceuticalisation. While the media may have such a role, this is in the main only for those who are receptive to such a message already.

This paper examines the extent to which the position of the medical profession and the state towards complementary and alternative medicine (CAM) practitioners has changed since the late 1990s, taking Portugal as a case study. Using Light's concept of countervailing powers, we consider the alliances, interests, rhetoric and degrees of control between these three actors over time, focussing particularly on the extent to which CAM practitioners have acted as a countervailing force in their relationship with the medical profession and the state. It also brings to the fore the position of supra-state agencies concerning CAM regulation. A critical discourse analysis was conducted on data derived from a systematic search of information dating from the late 1990s up to 2015. Our analysis suggests that CAM has emerged as an active player and a countervailing power in that it has had significant influence on the process of state policy-making. The medical profession, in turn, has moved from rejecting to 'incorporating' CAM, while the state has acted as a 'broker', trying to accommodate the demands and preferences of both actors while simultaneously demonstrating its power and autonomy in shaping health policy. In sum, the history of countermoves of CAM, the medical profession and the state in recasting power relations regarding CAM regulation in Portugal has highlighted the explanatory value of Light's countervailing power theory and the need to move away from a professional dominance and corporatist approach, in which CAM has simply been seen as subjugated to the power of the medical profession and the state.

Policy discourse shaped by neoliberal ideology, with its emphasis on marketisation and competition, has highlighted the importance of choice in the context of healthcare and health systems globally. Yet, evidence about how so-called consumers perceive and experience healthcare choice is in short supply and limited to specific healthcare systems, primarily in the Global North. This special issue aims to explore how choice is perceived and utilised in the context of different systems of healthcare throughout the world, where choice, at least in policy and organisational terms, has been embedded for some time. The articles are divided into those emphasising: embodiment and the meaning of choice; social processes associated with choice; the uncertainties, risks and trust involved in making choices; and issues of access and inequality associated with enacting choice. These sociological studies reveal complexities not always captured in policy discourse and suggest that the commodification of healthcare is particularly problematic.

From a socio-cultural standpoint, the concept of otherness is central to explaining the way risk is associated with certain social groups rather than others. In the mental health field, writers have frequently employed the concept of otherness to describe the ways in which mental health service users have been perceived, especially since the implementation of community care policies in the UK in the 1990s. Despite its popularity, few empirical studies have explored the concept of otherness and its use in explaining the risks associated with being mentally ill in any depth, and fewer still have done so in relation to professional practice. The present paper draws upon data from semi-structured interviews with 39 mental health social workers in order to explore the relevance of this concept in risk assessment. The paper employs the concept of liminal otherness as an analytic tool to explain how social workers assessed the risk of clients who were 'difficult to place' because of uncertainty about whether their behaviour was the result of their personality or their mental illness. It is concluded that liminality is relevant to understanding the following: the way in which some service users are found 'in-between' places in terms of service provision; the allocation of responsibility for the management of the risks they represent to social work as a liminal profession; and the symbolic importance of 'the street' as a liminal space within which forms of 'racial otherness' have become central to contemporary constructions of community care.

Since the late 1990s, the term ‘partnership’ has increasingly been inserted into the literature and rhetoric of the UK health-care system. In this paper, the assumptions and implications surrounding the usage of the term in relation to doctor–patient interaction are examined in the context of paediatric services. The paper considers recent ideas about partnership in medical encounters, especially those of Charles et al., and the extent to which they are applicable to children. The paper then goes on to develop a framework for understanding patient-partnership issues. It is argued that any investigation of partnership will need to take account of the organisational and legal setting, as well as the beliefs and agendas that all parties bring to the medical encounter. In the context of paediatrics, the perspectives of three actors—the child, parent and health service professional—need to be explored. Our framework allows for different sorts of ‘coalition’ to develop between these actors as they try to reconcile their perspectives in the clinic and offers a situationally contextualised view of partnership. We also argue that these matters require study outside as well as inside the clinic, through the use of a range of methods, including those that help children at home review their involvement in decision making in the clinic.

In 2001, the Home Office launched the Offender Assessment System to help probation and prison staff predict whether known violent offenders will reoffend. One of the paradoxes of a system that predicts future risk of offending is its failure to appraise the fear of staff working with these offenders. In this paper we look at the ways in which fear of violence is managed by probation staff in the course of their work. We consider the impact of fear upon work practices and relationships with colleagues, management and clients. We argue that offender risk assessments need to be cognizant of the extent to which fear may act as a warning sign to management of staff vulnerability and their capacity to work with those clients in accordance with their responsibilities.

This paper focuses on how adults with cystic fibrosis (CF) attending a specialist CF centre in the UK perceive their health. In common with many other genetic diseases, CF is traditionally conceptualised as a fatal childhood disease, yet the average survival age for those with CF has been steadily rising over the past half century. Thus it is now predicted that those born in 1990 will live on average for 40 years. To date, however, most sociological work has focused on children or adolescents affected by CF rather than on adults between the ages of 18 and 40, the focus of the study reported here. The paper shows that these adults' varying perceptions of health are related to the effects of CF, its treatment, and the context in which adults are placed. Four concepts of health are identified (health as 'normal', controllable, distressing and a release) along with certain styles, ways of coping and related strategies. Through these analytic distinctions the paper aims to make a contribution to the sociological understanding of lay concepts of health in adults with childhood or genetic disease.

and MARIA O’BEIRNE* This paper discusses the value of a multi-method approach for studying violence against professionals. It is based on a project currently conducted by the authors on the extent and impact of violence against three professions working in the community (General Practitioners, Probation Officers and Anglican Clergy). The paper starts by making some general points about the nature of our chosen occupations’ professional discourses on violence and then discusses how quantitative and qualitative methods can be used to establish the extent to which the definitions of violence embedded in these discourses are meaningful for individual professionals. It is argued that both kinds of method are necessary to understand fully individual professionals’ experiences of violence against them. The study reported here is an ongoing investigation of violence by members of the British public against three types of professional workers based in community rather than large institutional settings: National Health Service (NHS) general practitioners, probation officers and Anglican clergy. The research aims to assess the extent and impact of violence (and fear of violence) on these professionals, and the response of professional agencies and organizations to violence and risk of violence in general and to specific incidents. Within both the professional press for each group and the mass media in general, there are many claims that violence against members of these groups is increasing. Mass media reports are, of course, likely to focus on the sensational, the rare and hence newsworthy incidents, such as the murder of the Reverend Christopher Gray in August 1996. It is possible that apparently mundane and unnewsworthy incidents of harassment and verbal abuse are much more frequent and have a much more insidious impact on members of our three occupations. These three occupations might all be broadly characterized as professions. They all require a specialist training in a body of knowledge and craft skills. Members of these occupations have some autonomy in the organization of their work and all have some claim to be authority figures within the community or with respect to their clients. The decision to undertake a comparative study stemmed from our interest in the relationship between occupational cultures and organization and the experience of violence: behaviours that are regarded as ‘normal risks’ in one work setting may be perceived as exceptionally threatening in another occupational context. The focus on those who do ‘front-line work’ in the community, including clients’ homes, reflected our interest in the experience of those who work outside the environment of a large institution. Those who work in the community typically do so alone, at least during much of their face-toface contact with users of their services, and are faced with recurrent tensions between accessibility to clients and security.

We are at the dawn of a genetic age. The Human Genome Project, the largest biological research enterprise in history, promises to have our entire genetic structure mapped by 2001. Our media report new scientific claims of genes associated with diseases, conditions, behaviours or personality traits so regularly that it seems that we are being provided with a gene-of-theweek. Scientists have identified or claimed genes for cystic fibrosis, Huntington Disease, Fragile X syndrome, breast cancer, Alzheimer’s disease, colon cancer, bipolar illness, obesity, homosexuality, alcoholism, ‘novelty seeking’, shyness, bed wetting; the list gets longer weekly. James Watson, so-discoverer of the double helix structure of DNA and founding father of the Human Genome Project has declared, ‘We used to think our fate was in the stars. Now we know, in large part, it is in our genes’ (cited in Horgan 1993). The history of genetics is long and complex, encompassing numerous strands. In 1859 Gregor Mendel, an Austrian monk, discovered the rules of inheritance by doing carefully controlled breeding experiments with garden pea plants. In 1883 British scientist Frances Galton coined the term eugenics as ‘the science of improvement of the human race germplasm through better breeding’ (cited in Haller 1963: 3). For several decades eugenics thrived as both a form of ‘science’ and as a social movement. With the ‘rediscovery’ of Mendel’s laws at the turn of the century, the eugenic movement adopted a scientific mantle and prospered in both the US and UK. Attempts at eugenic hygiene included identifying ‘genetic defectives’, and controlling their procreation or assimilation into society through marriage and immigration laws as well as sterilisation of ‘undesirables’. In addition, eugenicists offered incentives for those deemed more generally fit (i.e. the upper classes) to increase their reproduction in order to improve the genetic stock. Prior to World War II, scientists and eugenicists proffered hereditarian theories of various diseases, conditions and behaviours. The eugenics movement flourished through the 30s, but eventually began to wane. Geneticists moved to separate themselves from the pseudo-science of eugenics, social scientists criticised the eugenicists’ faulty underlying assumptions, and the Nazis’

1. Health Beliefs and Knowledge 2. Inequalities and Patterning of Health and Illness 3. Professional and Patient Interactions 4. Chronic Illness and Disability 5. The Sociology of Evaluation and Politics of Health Care

Introduction PART ONE: SOCIAL PATTERNING OF HEALTH Social Class - Graham Scambler Gender - Ellen Annandale Ethnicity - James Y. Nazroo Place - Sally Macintyre and Anne Ellaway Material and Cultural Factors - Graham Scambler Psychosocial Factors - Antonia Bifulco Life Events - Antonia Bifulco Neo-liberal Globalization and Health Inequalities - Roberto De Vogli, Ted Schrecker and Ronald Labonte Ageing and the Life Course - Tarani Chandola Social Capital - Orla McDonnell PART TWO: EXPERIENCE OF HEATH AND ILLNESS Medicalization - Jonathan Gabe Illness and Health-Related Behaviour - Lee F. Monaghan Stigma - Lee F. Monaghan and Simon J. Williams Embodiment - Simon J. Williams and Lee F. Monaghan Emotions - Gillian Bendelow Chronic Illness - Mike Bury and Lee F. Monaghan Disability - Nicholas Watson Illness Narratives - Mike Bury and Lee F. Monaghan Risk - Jonathan Gabe The Sick Role - Mike Bury and Lee F. Monaghan Practitioner-Client Relationships - Alison Pilnick Quality of Life - Mary Boulton Awareness Contexts - Lee F. Monaghan PART THREE: HEALTH, KNOWLEDGE AND PRACTICE Medical Model - Mike Bury Social Constructionism - Orla McDonnell Lay Knowledge - Gareth H. Williams Reproduction - Jane Sandall Medical Technologies - Alex Faulkner eHealth - Michael Hardey Geneticization - Rebecca Dimond and Jacqueline Hughes Bioethics - Clare Williams and Steven P. Wainwright Surveillance and Health Promotion - Sarah Nettleton PART FOUR: HEALTH WORK AND THE DIVISION OF LABOUR Medical Autonomy, Dominance and Decline - Mary Ann Elston and Jonathan Gabe Trust in Medicine - Jonathan Gabe Nursing and Midwifery as Occupations - Abbey Hyde Social Divisions and Formal Health Care - Catherine Theodosius Health Professional Migration - Ivy Lynn Bourgeault Complementary and Alternative Medicine - Michael Hardey Emotional Labour - Catherine Theodosius Informal Care - Sue Hollinrake PART FIVE: HEALTH-CARE ORGANIZATION AND POLICY Hospitals and Health Care Organizations - Per Maseide Privatization - Jonathan Gabe Managerialism - Jonathan Gabe Consumerism - Jonathan Gabe Citizenship and Health - Gareth H. Williams Social Movements and Health - Nick Crossley Medicines Regulation - Jonathan Gabe Evaluation - Nicholas Mays Malpractice - Jonathan Gabe

This paper offers an analysis of the events surrounding the suspension of the licence for the widely used sleeping tablet Halcion (triazolam) by the British Licensing Authority in October 1991. It is argued that these events highlight a growing crisis in modern medical treatments and in the social relations of health care. This is illustrated by focusing on four elements which have contributed to Halcion becoming a public issue and to its suspension and subsequent banning, namely the claims-making activities of medical experts, the development of legal challenges to medicine, the role of the media and the response of the state.

Background: International nurse recruitment is an integral part of government health care strategy in many countries. However, the gendered implications of nurse migration have been little explored despite the fact that the nursing workforce is predominantly made up of women. Aim: Based on the migration of nurses from the English-speaking Caribbean region to the UK, this paper explores the significance of gender at both the macro and micro levels. Methods: Four strands of inquiry were explored: nurse migration, impact on development, work experiences and family life. Key terms were used to search the electronic databases SSCI, EBSCO and JSTOR. An interpretative framework based on the feminist theory of intersectionality was used to systematically review the 15 studies that met the inclusion criteria. Findings: Gender issues are significant across all aspects of the migratory process. Migrant nurses contribute to social progress through remittances and knowledge gained abroad although overall, nurse migration negatively impacts development and there are hidden implications for women. For some Caribbean nurses, migration reflects increased economic freedom; however, for others, gender inequality lies at the centre of the decision to relocate. Gender inequality also permeates the lives of many migrant nurses even in countries where economic and work conditions are improved. Conclusions: The ramifications of nurse migration cannot be fully understood without attention to gender inequalities and the specific socio-economic contexts in which they exist. There is need for a gender-centred approach to international nursing recruitment policy that takes account not only of the impact on developing countries, but also of the well-being of migrant nurses themselves.

The purpose of this paper is to illustrate the value of insights from media studies for medical sociology by focusing on the cultural and ideological messages transmitted in newspaper coverage of tranquilliser dependence. An analysis of 62 stories recounting the experiences of individual tranquilliser users reveals that journalists concentrate on two kinds of person – the celebrity and the ordinary user- in their reports. The ways in which the press deploys these users' experiences of tranquilliser dependence and withdrawal and their relationship with the medical profession are then analysed, with particular attention being given to the cultural and ideological meanings embedded in its descriptions of such experiences and relations. The paper ends with a discussion of the reasons for the transmission of such meanings by the press and their possible effect on different audiences.

Accounts of ageing often employ the metaphor of a mask and suggest that individuals are motivated to present a youthful image. Drawing on interview data, we reveal that women aged 51-57 years distinguish between what we call ‘public’ and ‘private’ body ageing, both of which have an impact on age-resistance. Public ageing is visible, arising from physical changes in body appearance. These changes have the potential for concealment through age-resisting activities. Private ageing is less visible and arises largely from physiological changes within the body, which were perceived by women as irreversible indicators of ageing. This obduracy of the body led women to perceive themselves as ageing and also deterred them from participating in age-resistance. In contrast to masking theories, our study shows that most women in their 50s wanted to project a socially acceptable image that reflected their subjective sense of growing old.

Social scientific studies of prescribed drug use have played an important part in heightening awareness that their use can best be understood when considered within a social context. From a sociological point of view, however, these studies often suffer from limitations which restrict their descriptive and explanatory power. This paper discusses these limitations before attempting to develop an alternative approach which focuses on the meanings attached to prescribed drug use, and relates these meanings to the ways in whch the users of these drugs manage their everyday lives as members of particular collectivities. In order to bridge the gap between structure and experience prescribed drugs are conceptualised as resources which, along with other material and socio-cultural resources, are both differentially available and variously experienced. Taking minor tranquillisers/hypnotics (e.g. Valium, Mogadon) as a test case attention is focused first on these drugs' availability to samples of black and white working-class women and the meanings which they attribute to these drugs. The different patterns of drug use which are found are then related to these women's varying access to and experience of a range of other resources (including paid work, social supports, leisure, cigarettes and religion). This provides a basis for explaining different patterns of drug use and hopefully illustrates the usefulness of ‘resource’ as a bridging concept between social structure and everyday life.

This paper attempts to highlight the value of the ‘social problem’ perspective for the sociology of health and illness by applying it to the issue of tranquilliser use and dependence. The approach involves focusing on the emergence of benzodiazepine tranquilliser dependence as a social problem and the extent to which it has been legitimated by the media and by the state. In the conclusion we draw out the implications of our case study for the development of a ‘natural history’ of social problems.

This paper develops an analysis of women's perceptions of medical technology and the elements which shape them, and then draws out the implications for medicine and the medicalization thesis. In the first part of the paper we outline the macro-theoretical debates about medicalization and the role of medical technology in this process, and the consequences for those who use health care. The implications for women are given particular attention as they have a higher level of contact with health care than men. We then evaluate the arguments of these macro-theorists against evidence from two ethnographic studies, concerning women patients' and their doctors' attitudes to the use of minor tranquillizers and women's evaluations of medicine and medical practice. This provides a basis for questioning some of the assumptions of the macro-theorists regarding the social relations of medical technology and the medicalization thesis.