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...

New pharmacological therapies, often dubbed `lifestyle drugs', demonstrate the enactment of yet another interface between technologies and bodies that promises a re-fashioning of the body with transformative, life-enhancing results. This article analyzes the emergence of one lifestyle drug, Viagra, from a technoscience studies perspective, conceptualizing Viagra as a new medical technology of the body. Through an analysis of promotional materials for Viagra, we argue that this pharmaceutical device performs ideological work through its discursive scripts that serves to reinforce and augment dominant cultural narratives in relation to material bodies, particularly those of hegemonic masculinity and male (and female) sexuality. We conclude that Viagra carries the potential to reify and reinforce these dominant and hegemonic narratives, while at the same time, through ensuring an open market for heterogeneous users, it provides spaces for alternatives to these normative ideals and assumptions.

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Issues and concerns among six directors, one counsellor and one consultant for transgender programmes in San Francisco are described. Additionally, 173 clients who were enrolled in programmes in eight AIDS service organizations were interviewed using a structured survey questionnaire. This study examined the relationships between HIV risk behaviours and social and cognitive factors among transgendered females (male-to-female transgenders) (n = 25) in comparison with homosexual or bisexual males (n = 122) and heterosexual females (n = 26). Transgendered females engaged in riskier behaviours than the other groups in terms of the number of sex partners in the past 30 days and the past six months, commercial sex activities, and having a steady sex partner who injected drugs. Adverse socioeconomic conditions and transgender-specific risk behaviours such as injecting hormones in relation to HIV risk behaviours must be targeted by future intervention studies.

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It has become common for nurses to be recruited into and/or seek careers outside of the traditional domain of hospital-based work. This article draws on interview data to consider a position nurses are occupying within biomedicine, that of the nurse clinical trial coordinator. It examines and analyzes the value attributed to such positions by nurse trial coordinators. The analysis reveals that nurses identify three aspects of the position-social relations, the acquisition of skills and knowledge, and work and control-as having both advantages and disadvantages over other work roles within nursing. It concludes with suggestions for further research on the role and involvement of nurses in clinical research.

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