katie featherstone | Cardiff University (original) (raw)
Papers by katie featherstone
The Journal of Rheumatology, Apr 1, 2003
The Journal of rheumatology, 2003
Social Studies of Science, 2010
This paper examines the role of complexity in descriptions of the aetiology of common psychiatric... more This paper examines the role of complexity in descriptions of the aetiology of common psychiatric disorders. While scientists attest to the discovery of an underlying reality of complex inheritance -the so-called 'witches' brew' of genetic and non-genetic factors -we argue that 'complexity' also performs rhetorical work. In our analysis of scientific review papers (1999-2008), we find a relatively stable genre of accountability in which descriptions of complexity appear to neutralize past failures by incorporating different and sometimes competing methodological perspectives. We identify two temporal strategies: retrospective accounting, which reconstructs a history of psychiatric genetics that deals with the recent failures, citing earlier twin studies as proof of the heritability of common psychiatric disorders; and prospective accounting, which engages in the careful reconstruction of expectations by balancing methodological limitations with moderated optimism. Together, these strategies produce a simple-to-complex narrative that belies the ambivalent nature of complexity. We show that the rhetorical construction of complexity in scientific review papers is oriented to bridging disciplinary boundaries, marshalling new resources and reconstructing expectations that justify delays in gene discovery and risk prediction.
Journal of Advanced Nursing, 2012
Aim. This article is a report of a study protocol designed to explore the experience of home peri... more Aim. This article is a report of a study protocol designed to explore the experience of home peritoneal dialysis from the perspectives of individuals, their families and healthcare professionals in the United Kingdom. Background. Peritoneal dialysis is an established life-saving treatment for end-stage renal disease. This daily treatment is undertaken at home, and nurses play a key role in supporting people with their dialysis and monitoring their condition. Although peritoneal dialysis is known to have an impact on peoples' quality of life, few studies have explored peoples' experiences of undertaking this treatment at home, nor investigated their families' and health professionals' perspectives.
There are numerous ways in which inheritance is managed socially and culturally. Insofar as cultu... more There are numerous ways in which inheritance is managed socially and culturally. Insofar as cultural forms are learned and are passed on from generation to generation, the array of human cultures, with all their extraordinary variety, is inherited. Although there may be some ...
The article reconsiders the nature and location of science in the development of genetic classifi... more The article reconsiders the nature and location of science in the development of genetic classification. Drawing on field studies of medical genetics, we explore how patient categorization is accomplished in between the clinic and laboratory. We focus on dysmorphology, a specialism concerned with complex syndromes that impair physical development. We show that dysmorphology is about more than fitting patients into prefixed diagnostic categories and that diagnostic process is marked by moments of uncertainty, ambiguity, and deferral. We describe how different forms of evidence are brought into play and how patterns of physical features are identified as genetic or not. We suggest that clinical categorical work helps articulate the genetic as an emergent domain of medical classification and that moments of ambiguity and deferral create an imperative space that helps legitimate the need for more technoscience, and consequently, more clinical judgment with which to fix the genetic future.
Medicina nei secoli, 2014
We provide an examination of the field of dysmorphology, a clinical speciality that in its curren... more We provide an examination of the field of dysmorphology, a clinical speciality that in its current form combines a long history of inspection and display with the identification and representation of associated underlying molecular changes. The recognition and description of abnormal appearances is thus increasingly accompanied by genetic and other molecular investigations. Our analysis draws on our long-term ethnographic engagement with a UK clinical genetics service and the work of two clinical genetics teams within a regional teaching hospital. We document the intersection of genetic science with clinical work to suggest that while molecular testing often identifies the genetic basis for unusual appearances and abnormal development, it does not fully supplant clinical apperception and interpretation. The two modes of knowledge--the clinical and the biomedical--co-exist in the work and the discourse of dysmorphology practice. The contemporary dysmorphology clinic thus encapsulates...
Trials, Jan 27, 2007
Qualitative methods are increasingly used to study the process of clinical trials and patients un... more Qualitative methods are increasingly used to study the process of clinical trials and patients understanding of the rationale for trials, randomisation and reasons for taking part or refusing. Patients' understandings are inevitably influenced by the recruiting clinician's understanding of the trial, yet relatively little qualitative work has explored clinicians' perceptions and understandings of trials. This study interviewed surgeons shortly after the multi-centre, pragmatic RCT in which they had participated had been completed. We used in-depth interviews with surgeons who participated in the Spine Stabilisation Trial (a pragmatic RCT) to explore their understanding of the trial purpose and how this understanding had influenced their recruitment procedures and interpretation of the results. A purposive sample of eleven participating surgeons was chosen from 8 of the 15 UK trial centres. Although the surgeons thought that the trial was addressing an important question ...
Social Science & Medicine, 2008
Symptoms play a crucial part in the formulation of medical diagnoses, yet the construction and in... more Symptoms play a crucial part in the formulation of medical diagnoses, yet the construction and interpretation of symptom narratives is not well understood. The diagnosis of angina is largely based on symptoms, but a substantial minority of patients diagnosed with ''non-cardiac'' chest pain go on to have a heart attack. In this ethnographic study our aims were to understand: (1) how the patients' accounts are performed or enacted in consultations with doctors; (2) the ways in which ambiguity in the symptom narrative is managed by doctors; and (3) how doctors reach or do not reach a diagnostic decision. We observed 59 consultations of patients in a UK teaching hospital with new onset chest pain who had been referred for a specialist opinion in ambulatory care. We found that patients rarely gave a history that, without further interrogation, satisfied the doctors, who actively restructured the complex narrative until it fitted a diagnostic canon, detaching it from the patient's interpretation and explanation. A minority of doctors asked about chest pain symptoms outside the canon. Re-structuring into the canonical classification was sometimes resisted by patients who contested key concepts, like exertion. Symptom narratives were sometimes unstable, with central features changing on interrogation and re-telling. When translation was required for South Asian patients, doctors considered the history less relevant to the diagnosis. Diagnosis and effective treatment could be enhanced by research on the diagnostic and prognostic value of the terms patients use to describe their symptoms.
Encyclopedia of Life Sciences, 2001
There are numerous ways in which inheritance is managed socially and culturally. Insofar as cultu... more There are numerous ways in which inheritance is managed socially and culturally. Insofar as cultural forms are learned and are passed on from generation to generation, the array of human cultures, with all their extraordinary variety, is inherited. Although there may be some ...
Sociology of Health and Illness, 2005
Dysmorphology is the medical study of abnormal forms in the human and is concerned with the ident... more Dysmorphology is the medical study of abnormal forms in the human and is concerned with the identification and classification of a variety of congenital malformations. Such diagnostic work rests on the inspection of images of affected individuals. Based on physical appearance individuals are classified in terms of a wide range of conditions, often with 'exotic' nomenclatures. This paper will describe the features of clinical dysmorphology and the process of classification. It derives from an ethnographic study of clinical consultations and meetings among medical geneticists in UK hospitals. We suggest that contemporary dysmorphology can be understood in terms of long-standing forms of medical knowledge, medical representations and medical discourse. Notwithstanding the new forms of technology provided by genetic science, 'the clinic' still asserts its symbolic and functional power: the 'gaze' of the clinician and the clinician's warrant of personal knowledge exert their influence. The adjudication of dysmorphology is a contemporary exemplar of the spectacular.
Sociology of Health & Illness, 2013
This article synthesises recent research examining how families live with genetic risk and the pr... more This article synthesises recent research examining how families live with genetic risk and the processes of genetic decision-making and disclosure among family members who have been or are at risk of transmitting a familial genetic condition. Its aim is to generate substantive theory that can inform our understanding of the interactional processes at work in the distribution of mutual knowledge and awareness of genetic risk in families. The article is structured around three interrelated concepts. Kinscape refers to the constellation of relations and relatedness that are recognised practically; timescape to the multiple temporal frames of social relations and their transformation and genescape to the constellation of knowledge, belief and practice surrounding genetic inheritance. All three concepts are simultaneously natural and cultural. Their intersections create the conditions of kinship and genetics.
Social Theory & Health, 2011
Some have argued that advances in molecular genetics will lead to the geneticisation of identity ... more Some have argued that advances in molecular genetics will lead to the geneticisation of identity and the subsequent reduction of the human subject to their genetic complement. In this article, we advance the more cautious argument that far from reducing subjectivity to ...
Science, Technology & Human Values, 2006
The article reconsiders the nature and location of science in the development of genetic classifi... more The article reconsiders the nature and location of science in the development of genetic classification. Drawing on field studies of medical genetics, we explore how patient categorization is accomplished in between the clinic and laboratory. We focus on dysmorphology, a specialism concerned with complex syndromes that impair physical development. We show that dysmorphology is about more than fitting patients into prefixed diagnostic categories and that diagnostic process is marked by moments of uncertainty, ambiguity, and deferral. We describe how different forms of evidence are brought into play and how patterns of physical features are identified as genetic or not. We suggest that clinical categorical work helps articulate the genetic as an emergent domain of medical classification and that moments of ambiguity and deferral create an imperative space that helps legitimate the need for more technoscience, and consequently, more clinical judgment with which to fix the genetic future.
New Genetics and Society, 2003
ABSTRACT The work of clinical geneticists includes the inspection of visible abnormalities and th... more ABSTRACT The work of clinical geneticists includes the inspection of visible abnormalities and their allocation to clinical categories. Drawing on observations of departmental clinical meetings in a medical genetics service, we describe how diagnostic work is accomplished through ...
New Genetics & Society, 2001
ABSTRACT Based on a period of ethnographic fi eldwork among geneticists, the paper explores how c... more ABSTRACT Based on a period of ethnographic fi eldwork among geneticists, the paper explores how clinicians and scientists construct families as objects of discourse. It documents how the family is constructed as a social object and as a set of biological relationships. The ...
Journal of Health Services Research & Policy, 2003
To examine the impact of including a &amp... more To examine the impact of including a 'no active intervention' arm (called 'conservative management') in a randomised controlled trial comparing treatments (including surgery) for men with lower urinary tract symptoms related to benign prostatic enlargement. Outcomes 7.5 months after randomisation were acceptability of randomisation, overall acceptability of and satisfaction with conservative management, impact on quality of life, perceived need for further treatment and treatment failure (defined a priori). In total, 177 (out of 755) patients refused randomisation, including 31% who did not want surgery and 22% who wanted surgery. Most men randomised to conservative management were willing to undertake it as part of a trial but at the end of the trial they were divided between those who wanted to continue with it and those who expected surgery. At follow-up, 39% of conservative management patients requested surgery, and interference of symptoms with life and an unsuccessful outcome were more commonly reported in this arm. There were no appreciable differences between treatment groups in terms of treatment failures. Including a 'no active intervention' arm did not appear to have a detrimental effect on patient recruitment or the completion of this trial in the short-term; overall, conservative management was successfully completed by the majority of patients during the trial period, suggesting that researchers need not avoid including a no-intervention arm in surgical trials as long as they take care with its presentation.
BMJ open, 2012
To examine functions of the exercise ECG in the light of the recent National Institute for Health... more To examine functions of the exercise ECG in the light of the recent National Institute for Health and Clinical Excellence guidelines recommending that it should not be used for the diagnosis or exclusion of stable angina.
The Journal of Rheumatology, Apr 1, 2003
The Journal of rheumatology, 2003
Social Studies of Science, 2010
This paper examines the role of complexity in descriptions of the aetiology of common psychiatric... more This paper examines the role of complexity in descriptions of the aetiology of common psychiatric disorders. While scientists attest to the discovery of an underlying reality of complex inheritance -the so-called 'witches' brew' of genetic and non-genetic factors -we argue that 'complexity' also performs rhetorical work. In our analysis of scientific review papers (1999-2008), we find a relatively stable genre of accountability in which descriptions of complexity appear to neutralize past failures by incorporating different and sometimes competing methodological perspectives. We identify two temporal strategies: retrospective accounting, which reconstructs a history of psychiatric genetics that deals with the recent failures, citing earlier twin studies as proof of the heritability of common psychiatric disorders; and prospective accounting, which engages in the careful reconstruction of expectations by balancing methodological limitations with moderated optimism. Together, these strategies produce a simple-to-complex narrative that belies the ambivalent nature of complexity. We show that the rhetorical construction of complexity in scientific review papers is oriented to bridging disciplinary boundaries, marshalling new resources and reconstructing expectations that justify delays in gene discovery and risk prediction.
Journal of Advanced Nursing, 2012
Aim. This article is a report of a study protocol designed to explore the experience of home peri... more Aim. This article is a report of a study protocol designed to explore the experience of home peritoneal dialysis from the perspectives of individuals, their families and healthcare professionals in the United Kingdom. Background. Peritoneal dialysis is an established life-saving treatment for end-stage renal disease. This daily treatment is undertaken at home, and nurses play a key role in supporting people with their dialysis and monitoring their condition. Although peritoneal dialysis is known to have an impact on peoples' quality of life, few studies have explored peoples' experiences of undertaking this treatment at home, nor investigated their families' and health professionals' perspectives.
There are numerous ways in which inheritance is managed socially and culturally. Insofar as cultu... more There are numerous ways in which inheritance is managed socially and culturally. Insofar as cultural forms are learned and are passed on from generation to generation, the array of human cultures, with all their extraordinary variety, is inherited. Although there may be some ...
The article reconsiders the nature and location of science in the development of genetic classifi... more The article reconsiders the nature and location of science in the development of genetic classification. Drawing on field studies of medical genetics, we explore how patient categorization is accomplished in between the clinic and laboratory. We focus on dysmorphology, a specialism concerned with complex syndromes that impair physical development. We show that dysmorphology is about more than fitting patients into prefixed diagnostic categories and that diagnostic process is marked by moments of uncertainty, ambiguity, and deferral. We describe how different forms of evidence are brought into play and how patterns of physical features are identified as genetic or not. We suggest that clinical categorical work helps articulate the genetic as an emergent domain of medical classification and that moments of ambiguity and deferral create an imperative space that helps legitimate the need for more technoscience, and consequently, more clinical judgment with which to fix the genetic future.
Medicina nei secoli, 2014
We provide an examination of the field of dysmorphology, a clinical speciality that in its curren... more We provide an examination of the field of dysmorphology, a clinical speciality that in its current form combines a long history of inspection and display with the identification and representation of associated underlying molecular changes. The recognition and description of abnormal appearances is thus increasingly accompanied by genetic and other molecular investigations. Our analysis draws on our long-term ethnographic engagement with a UK clinical genetics service and the work of two clinical genetics teams within a regional teaching hospital. We document the intersection of genetic science with clinical work to suggest that while molecular testing often identifies the genetic basis for unusual appearances and abnormal development, it does not fully supplant clinical apperception and interpretation. The two modes of knowledge--the clinical and the biomedical--co-exist in the work and the discourse of dysmorphology practice. The contemporary dysmorphology clinic thus encapsulates...
Trials, Jan 27, 2007
Qualitative methods are increasingly used to study the process of clinical trials and patients un... more Qualitative methods are increasingly used to study the process of clinical trials and patients understanding of the rationale for trials, randomisation and reasons for taking part or refusing. Patients' understandings are inevitably influenced by the recruiting clinician's understanding of the trial, yet relatively little qualitative work has explored clinicians' perceptions and understandings of trials. This study interviewed surgeons shortly after the multi-centre, pragmatic RCT in which they had participated had been completed. We used in-depth interviews with surgeons who participated in the Spine Stabilisation Trial (a pragmatic RCT) to explore their understanding of the trial purpose and how this understanding had influenced their recruitment procedures and interpretation of the results. A purposive sample of eleven participating surgeons was chosen from 8 of the 15 UK trial centres. Although the surgeons thought that the trial was addressing an important question ...
Social Science & Medicine, 2008
Symptoms play a crucial part in the formulation of medical diagnoses, yet the construction and in... more Symptoms play a crucial part in the formulation of medical diagnoses, yet the construction and interpretation of symptom narratives is not well understood. The diagnosis of angina is largely based on symptoms, but a substantial minority of patients diagnosed with ''non-cardiac'' chest pain go on to have a heart attack. In this ethnographic study our aims were to understand: (1) how the patients' accounts are performed or enacted in consultations with doctors; (2) the ways in which ambiguity in the symptom narrative is managed by doctors; and (3) how doctors reach or do not reach a diagnostic decision. We observed 59 consultations of patients in a UK teaching hospital with new onset chest pain who had been referred for a specialist opinion in ambulatory care. We found that patients rarely gave a history that, without further interrogation, satisfied the doctors, who actively restructured the complex narrative until it fitted a diagnostic canon, detaching it from the patient's interpretation and explanation. A minority of doctors asked about chest pain symptoms outside the canon. Re-structuring into the canonical classification was sometimes resisted by patients who contested key concepts, like exertion. Symptom narratives were sometimes unstable, with central features changing on interrogation and re-telling. When translation was required for South Asian patients, doctors considered the history less relevant to the diagnosis. Diagnosis and effective treatment could be enhanced by research on the diagnostic and prognostic value of the terms patients use to describe their symptoms.
Encyclopedia of Life Sciences, 2001
There are numerous ways in which inheritance is managed socially and culturally. Insofar as cultu... more There are numerous ways in which inheritance is managed socially and culturally. Insofar as cultural forms are learned and are passed on from generation to generation, the array of human cultures, with all their extraordinary variety, is inherited. Although there may be some ...
Sociology of Health and Illness, 2005
Dysmorphology is the medical study of abnormal forms in the human and is concerned with the ident... more Dysmorphology is the medical study of abnormal forms in the human and is concerned with the identification and classification of a variety of congenital malformations. Such diagnostic work rests on the inspection of images of affected individuals. Based on physical appearance individuals are classified in terms of a wide range of conditions, often with 'exotic' nomenclatures. This paper will describe the features of clinical dysmorphology and the process of classification. It derives from an ethnographic study of clinical consultations and meetings among medical geneticists in UK hospitals. We suggest that contemporary dysmorphology can be understood in terms of long-standing forms of medical knowledge, medical representations and medical discourse. Notwithstanding the new forms of technology provided by genetic science, 'the clinic' still asserts its symbolic and functional power: the 'gaze' of the clinician and the clinician's warrant of personal knowledge exert their influence. The adjudication of dysmorphology is a contemporary exemplar of the spectacular.
Sociology of Health & Illness, 2013
This article synthesises recent research examining how families live with genetic risk and the pr... more This article synthesises recent research examining how families live with genetic risk and the processes of genetic decision-making and disclosure among family members who have been or are at risk of transmitting a familial genetic condition. Its aim is to generate substantive theory that can inform our understanding of the interactional processes at work in the distribution of mutual knowledge and awareness of genetic risk in families. The article is structured around three interrelated concepts. Kinscape refers to the constellation of relations and relatedness that are recognised practically; timescape to the multiple temporal frames of social relations and their transformation and genescape to the constellation of knowledge, belief and practice surrounding genetic inheritance. All three concepts are simultaneously natural and cultural. Their intersections create the conditions of kinship and genetics.
Social Theory & Health, 2011
Some have argued that advances in molecular genetics will lead to the geneticisation of identity ... more Some have argued that advances in molecular genetics will lead to the geneticisation of identity and the subsequent reduction of the human subject to their genetic complement. In this article, we advance the more cautious argument that far from reducing subjectivity to ...
Science, Technology & Human Values, 2006
The article reconsiders the nature and location of science in the development of genetic classifi... more The article reconsiders the nature and location of science in the development of genetic classification. Drawing on field studies of medical genetics, we explore how patient categorization is accomplished in between the clinic and laboratory. We focus on dysmorphology, a specialism concerned with complex syndromes that impair physical development. We show that dysmorphology is about more than fitting patients into prefixed diagnostic categories and that diagnostic process is marked by moments of uncertainty, ambiguity, and deferral. We describe how different forms of evidence are brought into play and how patterns of physical features are identified as genetic or not. We suggest that clinical categorical work helps articulate the genetic as an emergent domain of medical classification and that moments of ambiguity and deferral create an imperative space that helps legitimate the need for more technoscience, and consequently, more clinical judgment with which to fix the genetic future.
New Genetics and Society, 2003
ABSTRACT The work of clinical geneticists includes the inspection of visible abnormalities and th... more ABSTRACT The work of clinical geneticists includes the inspection of visible abnormalities and their allocation to clinical categories. Drawing on observations of departmental clinical meetings in a medical genetics service, we describe how diagnostic work is accomplished through ...
New Genetics & Society, 2001
ABSTRACT Based on a period of ethnographic fi eldwork among geneticists, the paper explores how c... more ABSTRACT Based on a period of ethnographic fi eldwork among geneticists, the paper explores how clinicians and scientists construct families as objects of discourse. It documents how the family is constructed as a social object and as a set of biological relationships. The ...
Journal of Health Services Research & Policy, 2003
To examine the impact of including a &amp... more To examine the impact of including a 'no active intervention' arm (called 'conservative management') in a randomised controlled trial comparing treatments (including surgery) for men with lower urinary tract symptoms related to benign prostatic enlargement. Outcomes 7.5 months after randomisation were acceptability of randomisation, overall acceptability of and satisfaction with conservative management, impact on quality of life, perceived need for further treatment and treatment failure (defined a priori). In total, 177 (out of 755) patients refused randomisation, including 31% who did not want surgery and 22% who wanted surgery. Most men randomised to conservative management were willing to undertake it as part of a trial but at the end of the trial they were divided between those who wanted to continue with it and those who expected surgery. At follow-up, 39% of conservative management patients requested surgery, and interference of symptoms with life and an unsuccessful outcome were more commonly reported in this arm. There were no appreciable differences between treatment groups in terms of treatment failures. Including a 'no active intervention' arm did not appear to have a detrimental effect on patient recruitment or the completion of this trial in the short-term; overall, conservative management was successfully completed by the majority of patients during the trial period, suggesting that researchers need not avoid including a no-intervention arm in surgical trials as long as they take care with its presentation.
BMJ open, 2012
To examine functions of the exercise ECG in the light of the recent National Institute for Health... more To examine functions of the exercise ECG in the light of the recent National Institute for Health and Clinical Excellence guidelines recommending that it should not be used for the diagnosis or exclusion of stable angina.