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The first social transformation of American medicine institutionally established medicine by the end of World War II. In the next decades, medicalization-the expansion of medical jurisdiction, authority, and practices into new realms-became widespread. Since about 1985, dramatic changes in both the organization and practices of contemporary biomedicine, implemented largely through the integration of technoscientific innovations, have been coalescing into what the authors call biomedicalization, a second "transformation" of American medicine. Biomedicalization describes the increasingly complex, multisited, multidirectional processes of medicalization, both extended and reconstituted through the new social forms of highly technoscientific biomedicine. The historical shift from medicalization to biomedicalization is one from control over biomedical phenomena to transformations of them. Five key interactive processes both engender biomedicalization and are produced through it: (1) the political economic reconstitution of the vast sector of biomedicine; (2) the focus on health itself and the elaboration of risk and surveillance biomedicines; (3) the increasingly technological and scientific nature of biomedicine; (4) transformations in how biomedical knowledges are produced, distributed, and consumed, and in medical information management; and (5) transformations of bodies to include new properties and the production of new individual and collective technoscientific identities.
THE GROWTH OF medicalization-defined as the processes through which aspects of life previously outside the jurisdiction of medicine come to be construed as medical problems-is one of the most potent social transformations of the last half of the twentieth century in the West (Bauer 1998; Clarke and Olesen 1999; Conrad 1992, 2000; Renaud 1995). We argue that major, largely technoscientific changes in biomedicine1 are now coalescing into what we call biomedicalization2 and are transforming the twenty-first century. Biomedicalization is our term for the increasingly complex, multisited, multidirectional processes of medicalization that today are being both extended and reconstituted through the emergent social forms and practices of a highly and increasingly technoscientific biomedicine. We signal with the "bio" in biomedicalization the transformations of both the human and nonhuman made possible by such technoscientific innovations as molecular biology, biotechnologies, genomization, transplant medicine, and new medical technologies. That is, medicalization is intensifying, but in new and complex, usually technoscientifically enmeshed ways.
Institutionally, biomedicine is being reorganized not only from the top down or the bottom up but from the inside out. This is occurring largely...