Creating an (ethical) epistemic space for the normalization of clinical and "real food" oral immunotherapy for food allergy.

Researchers and sociologists have argued the consequences of standardization vis-à-vis clinical practice guidelines are diverse and argue they should be explored empirically. Sociologists have also argued that "best evidence" for the development of clinical practice guidelines is not restricted to randomized controlled trials and that other forms of knowledge should be embedded in and inform CPGs. There is little research concerning how other types of knowledge are mobilized and taken up in CPGs. This article presents the results of an ethnographic investigation in Canada between 2015 and 2020 of the development of a clinical practice guideline for immunotherapy for food allergy. My research shows that immunotherapy has become the source of controversy regarding whether immunotherapy should be offered in the clinic or remain experimental and whether it should be offered using food or commercial products. I argue that the clinical practice guideline for oral immunotherapy reaffirms what has been previously noted by sociologists; guidelines can serve normative purposes and are not merely technical documents. This case study is unique as it demonstrates how guidelines can serve as "community-making devices" to consolidate "epistemic communities" through the explicit and formal mobilization of ethical principles alongside other forms of "traditional" evidence. The mobilization of a multi-criteria approach that included ethical principles was mobilized in part to counter the de-legitimization and peripheralization of clinical and real food oral immunotherapy.

Passive tolerance and productive uncertainties in food allergy immunotherapy biomedical practices.

There has been little sociological research on food allergy in North America, despite the fact that it impacts a significant population in the US and Canada. Immunotherapy for food allergy is now a prominent area of investigation and experts argue it is one dimension of a 'paradigm shift' that encourages exposure to food allergens in contrast to avoidance of them. This article reports on an ethnographic investigation of immunotherapy for food allergy research and practice between the years 2015 and 2020. I report on analyses of N = 31 in-depth interviews with spokespersons with different types of engagement in immunotherapy and over 100 h of ethnographic observations at clinical and scientific conferences. My research revealed the entangled ontologies of food and drug in immunotherapy and related uncertainties in the diagnoses of food allergy, which catalysed further uncertainty about who is receiving and who should receive immunotherapy (IT). Relatedly, there are uncertainties about the goals and/or outcomes of IT. I elaborate on previous sociological work about how uncertainty is valued in medicine and science. I argue shared uncertainties and mutual scepticism in IT co-exist, representing a passive (productive) tolerance and reticently accepted form of tension in the domain, which have resulted in calls for intra-professional and inter-professional collaborations and the involvement of other stakeholders in knowledge making regarding food allergy immunotherapy.

Interventions to Reduce Opioid Use in Youth At-Risk and in Treatment for Substance Use Disorders: A Scoping Review.

BACKGROUND: Youth and young adults have been significantly impacted by the opioid overdose and health crisis in North America. There is evidence of increasing morbidity and mortality due to opioids among those aged 15-29. Our review of key international reports indicates there are few youth-focused interventions and treatments for opioid use. Our scoping review sought to identify, characterize, and qualitatively evaluate the youth-specific clinical and pre-clinical interventions for opioid use among youth. METHOD: We searched MedLine and PsycInfo for articles that were published between 2013 and 2021. Previous reports published in 2015 and 2016 did not identify opioid-specific interventions for youth and we thus focused on the time period following the periods covered by these prior reports. We input three groups of relevant keywords in the aforementioned search engines. Specifically, articles were included if they targeted a youth population (ages 15-25), studied an intervention, and measured impacts on opioid use. RESULTS: We identified 21 studies that examined the impacts of heterogeneous interventions on youth opioid consumption. The studies were classified inductively as psycho-social-educational, pharmacological, or combined pharmacological-psycho-social-educational. Most studies focused on treatment of opioid use disorder among youth, with few studies focused on early or experimental stages of opioid use. A larger proportion of studies focused heavily on male participants (i.e., male gender and/or sex). Very few studies involved and/or included youth in treatment/program development, with one study premised on previous research about sexual minority youth. CONCLUSIONS: Research on treatments and interventions for youth using or at-risk of opioids appears to be sparse. More youth involvement in research and program development is vital. The intersectional and multi-factorial nature of youth opioid use and the youth opioid crisis necessitates the development and evaluation of novel treatments that address youth-specific contexts and needs (i.e., those that address socio-economic, neurobiological, psychological, and environmental factors that promote opioid use among youth).