FOR BETTER, FOR WORSE: CRITICAL REFLECTIONS ON RISK, MEDICALIZATION AND OSTEOPOROSIS

Preventive medicine comes with the potential for making our lives both better and worse. In this thesis reflections around this situation are offered, supported by empirical research. The reflections are offered from a social constructionist position. Three themes are covered – the concept of risk in medicine, medicalization and osteoporosis. The study is based on six sub-studies applying a mix of qualitative methods. It covers data sets from medical literature databases, newspaper articles and focus groups. Among the findings of the study is the risk epidemic in medical literature, which has hitherto been found to peak in the first decade of the 21st century. Furthermore, the development of the medical understanding of osteoporosis has been traced, showing how the introduction of medical technology transformed it into a risk factor available for risk reducing interventions. The introduction of such reductions through chemoprevention was subject to controversy, and this controversy has been analysed through the newspaper coverage of what became known as the Fosamax-case. Knowledge of osteoporosis among women in Nord-Trøndelag has furthermore been shown to be based on everyday experiences wherein falling has become the ultimate test of osteoporosis. The experience of screening for osteoporosis among the same women illustrates that the medical definition of osteoporosis made little sense to them. Variation in risk categorization and measurement technology contributed to confusion over the test outcomes, as did the communication of test results as standard deviations. In the last paper reflections are offered on whether the pathologization of normality presents a possibility for unlimited medicalization. These findings show how modern information technology paired with the idea of risk in medicine has prepared the ground for the medicalization of everyday life. The medicalization of osteoporosis is described as happening three times over, through the medicalization of everyday life, the medicalization of menopause and the specific medicalization of osteoporosis. Bone density measurements are described as a crucial ingredient in the medicalization of osteoporosis, alongside chemoprevention. Recent developments show that bone density measurements may come to play a minor role in the future, however. Among the limits of medicalization are what in medical terms is described as lack of risk awareness and knowledge of osteoporosis, alongside a reluctance to take chemoprevention as a measure for reducing the risk of fractures. These limits to medicalization are unintended, however, unlike earlier feminist resistance against the medicalization of menopause. The consequences of screening for osteoporosis show that it has a reassuring effect on the women told that their bone density is OK, whereas for others it is a source of confusion. For some it also has the effect of demonstrating the frailty of their bodies