Experiences of the clinical academic pathway: a qualitative study in Greater Manchester to improve the opportunities of minoritised clinical academics.

OBJECTIVES: The aim of this study was to explore the barriers and facilitators faced by clinical academics (CAs) in the Greater Manchester region, with particular attention to the experiences of minoritised groups. DESIGN: A qualitative study using semistructured interviews and focus groups was conducted. A reflexive thematic analysis was applied to identify key themes. SETTING: University of Manchester and National Health Service Trusts in the Greater Manchester region. PARTICIPANTS: The sample of this study was composed of 43 participants, including CAs, senior stakeholders, clinicians and medical and dental students. RESULTS: Six themes were identified. CAs face several barriers and facilitators, some of which-(1) funding insecurity and (2) high workload between the clinic and academia-are common to all the CAs. Other barriers, including (3) discrimination that translates into struggles with self-worth and feeling of not belonging, (4) being or being perceived as foreign and (5) unequal distribution of care duties, particularly affect people from minoritised groups. In contrast, (6) mentorship was commonly identified as one of the most important facilitators. CONCLUSIONS: Cultural and structural interventions are needed, such as introducing financial support for early career CAs and intercalating healthcare students to promote wider social and cultural change and increase the feelings of belonging and representation across the entire CA pipeline.

Coexisting cancer regimes: Transformations of breast and lung cancer in the United Kingdom.

Using in-depth interviews with medical professionals working in the UK, I explore the coexistence of two different cancer regimes in which the different innovations for breast and lung cancer can be located. Breast cancer treatment has seen a protracted series of significant innovations in the context of an emphasis on screening that coexists with a segmentation in subtypes that has allowed targeted therapies for most patients. Lung cancer has also seen the introduction of targeted therapies; however, these can only be used for small groups of patients. Consequently, some interviewees working on lung cancer have expressed a stronger focus on increasing the number of patients undergoing surgery, as well as introducing screening also for lung cancer. As a result, a cancer regime based on the promises of targeted therapies coexists with a more traditional approach that focuses on diagnosing and treating cancers in their early stages.

The nebula of chronicity: dealing with metastatic breast cancer in the UK.

In this article, I explore how the concept of chronicity is mobilised by different actors in reference to metastatic breast cancer (MBC) and the transformation of the condition as a consequence of medical innovations. I do so by using data collected in the UK between 2017 and 2019 through in-depth interviews with medical professionals involved in the treatment of MBC and with patients living with MBC. I show how chronicity appears as a multidimensional and uncertain concept, which I analyse through the image of the nebula. While the medical literature tends to consider MBC chronic or on route to chronicisation, the medical professionals interviewed were uncertain as to whether MBC can be considered a chronic disease, and attempted to discuss chronicity through survival times, the kind of management possible for the disease, and how it compares to other conditions more commonly considered chronic. In some cases, the patients considered the idea of chronicity a source of hope or a way to link their condition to those of people with other diseases; however, they generally rejected the definition as inappropriate for their experience of the illness. Analysing the fluid uses of the concept of chronicity in the case of MBC contributes to the debate within medical anthropology on how medical categories acquire different values and uses and on the circulation of meanings between the biomedical context and the patient experience.

Anthropology of new chronicities: illness experiences under the promise of medical innovation as long-term treatment.

In the introduction to the special issue, Greco and Graber discuss the concept of chronicity and the ways it is used in the contributions to the special issue. Historians have shown that the concept of chronic disease has its origins in policy and has always been fluid and vague; however, the classic literature in sociology and nursing has focused on modelling the evolution of chronic disease rather than on examining the concept itself. In the introduction, chronicity is explored in the ways in which it is transformed by medical innovation. Innovations in biomedicine promise to turn terminal and acute conditions in chronic and to render chronic conditions curable. Even when such promises are not fulfilled, they change the context of the illness and the experiences of patients. In such a context a specific work is required from patients, in terms of adherence to the treatments, but also in terms of pursuing experimental treatments that could make their condition chronic. The introduction offers a critical exploration of the concept of chronicity, highlighting both its fluid definition and the changes linked to medical innovation, and the ways in which it shapes the temporalities and experiences of illness in complex ways that cannot be reduced to simplified schemas and trajectories.

The Uncertain Presence: Experiences of Living with Metastatic Breast Cancer.

Drawing from interviews with women with metastatic breast cancer in the UK and France, in this article I analyze uncertainties linked to this condition. In particular, I show how the impossibility of foreseeing the evolution of the condition, also as an indirect consequence of medical innovation, initiates an irreparable disruption of life after diagnosis. I further show how the lives of the patients are not only limited by the illness, but also by the difficulty of finding a place in society. I argue that such experiences are best understood through the concept of the crisis of the presence.

Cancer, COVID-19, and the need for critique.

In this open letter we examine the implications of the coronavirus disease 2019 (COVID-19) pandemic for cancer research and care from the point of view of the social studies of science, technology, and medicine. We discuss how the pandemic has disrupted several aspects of cancer care, underscoring the fragmentation of institutional arrangements, the malleable priorities in cancer research, and the changing promises of therapeutic innovation. We argue for the critical relevance of qualitative social sciences in cancer research during the pandemic despite the difficulties of immersive kinds of fieldwork. Social science research can help understand the ongoing, situated and lived impact of the pandemic, as well as fully underline its socially stratified consequences. We outline the risk that limiting and prioritising research activities according to their immediate clinical outcomes might have in the relational and longitudinal understanding of cancer practices in the UK. Finally, we alert against potential distortions that a "covidization" of cancer research might entail, arguing for the need to maintain a critical point of view on the pandemic.

Moving for Cures: Breast Cancer and Mobility in Italy.

I combine the theoretical tools of medical anthropology and the framework of mobility studies to explore the intranational movements of women with breast cancer from Southern and Northern Italy. Differences include patients' technical and moral evaluations of doctors, that influence the patients' definitions of cure and illness experiences through their mobility and immobility. These (im)mobilities are, in turn, linked to the material and symbolic inequalities between Southern and Northern Italy and to the stigma attached to the south. These (im)mobilities suggest the need to further articulate the concept of cure.

The Poly Implant Prothèse breast prostheses scandal: Embodied risk and social suffering.

This article examines the 2010 scandal surrounding the use and subsequent recall of adulterated Poly Implant Prothèse (PIP) silicone breast prostheses in France. It uses a mixed method approach that includes 12 interviews with French PIP prosthesis recipients, analyses of medical literature, policy documents of French and EU regulatory agencies, and an online forum for PIP recipients. These data are used to explain how the definition of "acceptable risk" in the silicone implants controversy of the 1990s in the US influenced the PIP scandal later on in France. Additionally, PIP recipients had an embodied experience of risk that clashed with the definition of risk used by authorities and some surgeons. The coverage of re-implantation was also defined at different policy levels, leading to variation in patients' suffering. The combination of fraud and lack of recognition from part of the medical system constitutes an example of social suffering for the patients involved. The PIP scandal is a useful case for analyzing the interconnection of embodied experience and professional and public policy definitions of medical risk through the concepts of moral economy and biological citizenship.