Treatment adherence redefined: a critical analysis of technotherapeutics

Abstract

GAGNON M, JACOB JD and GUTA A. Nursing Inquiry 2013; 20: 60–70 Treatment adherence redefined: a critical analysis of technotherapeuticsTreatment adherence issues in the context of chronic illnesses have become an important concern worldwide and a top priority in the field of health-care. The development of devices that will allow healthcare providers to track treatment adherence and monitor physiological parameters with exact precision raises important questions and concerns. The aim of this study is to interrogate the use of these new technological devices which allow for previously unavailable data to be recorded on an ongoing basis and transmitted via a tiny microchip inserted into the body. Drawing on the work of Michel Foucault, we analyze how this anatomo-political and bio-political instrument serves to discipline chronically ill individuals and govern the health of entire populations who suffer from chronic conditions. To support our analysis, this article comprises three sections. First, we provide an overview of treatment adherence and technotherapeutics. Then, we explain how technotherapeutics concern the government of bodies and conducts at the individual level and population level more generally. Lastly, we provide an example of how this analysis can be connected to routine nursing practice in the field of HIV.

Rethinking agency and medical adherence technology: applying Actor Network Theory to the case study of Digital Pills

“…What Michael and Michael call a state of überveillance and where Lupton is concerned with wireless technologies in health‐care, Gagnon and colleagues () are concerned with what they term ‘technotherapeutics’, or the use of new medical data tracking devices such as microchips. All these devices essentially discipline chronically ill patients while intrusively surveilling the aggregate population of patients; thus, they call new medical devices that are able to affectively track patient data ‘anatomo‐political’ and ‘biopolitical’ instruments of domination (Gagnon, Daniel and Guta , 14). Gagnon and colleagues () use Foucault's conceptualization of power in the context of adherence as politics.…”

“…All these devices essentially discipline chronically ill patients while intrusively surveilling the aggregate population of patients; thus, they call new medical devices that are able to affectively track patient data ‘anatomo‐political’ and ‘biopolitical’ instruments of domination (Gagnon, Daniel and Guta , 14). Gagnon and colleagues () use Foucault's conceptualization of power in the context of adherence as politics. By problematizing the management of the human immune‐deficiency virus (HIV) infection, they describe how technotherapeutics is a way to ‘allow healthcare providers to identify those who “fail” to maintain an undetectable viral load because of poor treatment adherence … In this sense, technotherapeutics would not only reinforce surveillance but also create new opportunities for the management of people living with HIV’ (Gagnon et al.…”

“…By problematizing the management of the human immune‐deficiency virus (HIV) infection, they describe how technotherapeutics is a way to ‘allow healthcare providers to identify those who “fail” to maintain an undetectable viral load because of poor treatment adherence … In this sense, technotherapeutics would not only reinforce surveillance but also create new opportunities for the management of people living with HIV’ (Gagnon et al. , 67). Medical technology, as observed by Foucault and as reinforced by history may in the short term empower individuals, but they will ultimately serve to discipline bodies and regulate populations.…”

“…Although some medical technology scholars tend to think about medical devices like DPs as social control mechanisms (cf. Michael and Michael 2010;Gagnon et al 2013), we can contextualize technological devices within a network of actors that negotiate the meaning and role of medical technology if we use ANT. The medical technology literature perceives medical technologies as the materialization of Foucault's panopticon or biopolitics because patients are under constant surveillance or the target of control (cf.…”

“…The medical technology literature perceives medical technologies as the materialization of Foucault's panopticon or biopolitics because patients are under constant surveillance or the target of control (cf. Holmes 2001;Lupton 2012;Gagnon et al 2013). Although power can play an important role in the context of doctor-patient relationships, it may be problematic to readily assume that technology is always used as a social control mechanism imposed upon disempowered patients.…”