JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact support@jstor.org.. American Sociological Association is collaborating with JSTOR to digitize, preserve and extend access to American Sociological Review. The first social transformation of American medicine institutionally established medicine by the end of World War II. In the next decades, medicalization-the expansion of medical jurisdiction, authority, and practices into new realms-became widespread. Since about 1985, dramatic changes in both the organization and practices of contemporary biomedicine, implemented largely through the integration of technoscientific innovations, have been coalescing into what the authors call biomedicalization, a second "transformation" of American medicine. Biomedicalization describes the increasingly complex, multisited, multidirectional processes of medicalization, both extended and reconstituted through the new social forms of highly technoscientific biomedicine. The historical shift from medicalization to biomedicalization is one from control over biomedical phenomena to transformations of them. Five key interactive processes both engender biomedicalization and are produced through it: (1) the political economic reconstitution of the vast sector of biomedicine; (2) the focus on health itself and the elaboration of risk and surveillance biomedicines; (3) the increasingly technological and scientific nature of biomedicine; (4) transformations in how biomedical knowledges are produced, distributed, and consumed, and in medical information management; and (5) transformations of bodies to include new properties and the production of new individual and collective technoscientific identities. HE GROWTH OF medicalization-defined as the processes through which aspects of life previously outside the jurisdiction of medicine come to be construed as medical problems-is one of the most potent social transformations of the last half of the Direct correspondence to Adele E. Clarke, Department . We argue that major, largely technoscientific changes in biomedi-cine1 are now coalescing into what we call Sara Shostak, and especially Leigh Star, Herbert Gottweis, Vincanne Adams, and the ASR Editors and anonymous reviewers. This paper is part of an ongoing collaboration initiated by Clarke; coauthors are listed in random order. 1 Following Latour (1987), we use the term "technoscience" to indicate an explicit move past scholarly traditions that separated science and technology conceptually and analytically. We argue that these two domains should be regarded as co-constitutive; we thus challenge the notion AMERICAN SOCIOLOGICAL REVIEW, 2003, VOL. 68 (APRIL: 161-194) 161 162 AMERICAN SOCIOLOGICAL REVIEW biomedicalization2 and are transforming the twenty-first century. Biomedicaliza...

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Recently, two prescription drugs (tamoxifen and raloxifene) have become salient to breast cancer prevention. With the advent of these drugs, referred to as “chemoprevention,” a mandate has emerged to classify certain women as high risk for breast cancer to determine a group of legitimate users of the drugs. This article examines the development and standardization of the model used to create such a group of high-risk women. The author argues that while the model remains uncertain and controversial, it has become the standard tool for the many jobs associated with legitimizing chemoprevention use in the United States. It has become the assumed standard—shaping practices, identities, and definitions—through its organizational embeddedness in the multiple practices and public images of chemoprevention despite its uncertainty and widespread critique.

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