Nelly Oudshoorn

University of Twente | UT · Department of Science, Technology and Policy Studies (STePS)

This essay is part of a Thematic Collection of Science, Technology & Human Values on the work of Adele E. Clarke (1945–2024).

Boenink et al. (Emerging technologies for diagnosing Alzheimer’s disease. Innovating with care. Basingstoke: Palgrave Macmillan, 2016) focus on innovation in early diagnostics for Alzheimer’s.

This chapter addresses the emotional distress that may emerge when bodies are implanted with heart-rhythm devices. To avoid the pitfall of framing emotional distress as an inherent characteristic of individuals, I suggest it is important to take into account the different reasons why people receive defibrillators in the first place, particularly ag...

This chapter aims to unravel how gender and age intersect in the ways in which women learn to live with pacemakers and ICDs. Although all wired heart cyborgs have to appropriate their technologically transformed bodies, women may face other vulnerabilities, partly because these devices are designed to fit adult male bodies. During my fieldwork, I l...

In this chapter, I argue that the passage from life to death is not the same for wired heart cyborgs as it is for people living without internal heart devices. Because defibrillators and pacemakers have the potential to stave off death, these technologies introduce a major dilemma. How long should one continue ‘using’ internal heart devices when pe...

In many popular and medical accounts, pacemakers and internal cardioverter defibrillators (ICDs) are often portrayed as almost magical technologies. Once implanted in bodies, they will work automatically by themselves and don’t require any agency of their ‘users.’ As I argue in this book, any discourse or policy that assumes a passive role of peopl...

At first glance, we may be inclined to think that the life cycle of hybrid bodies ends when wired heart cyborgs die. However, during my fieldwork, I learnt that pacemakers removed from deceased bodies are reprocessed to be used in new bodies. This chapter therefore traces what happens after death. Adopting the path creation approach, I describe how...

To understand the merging of humans with technologies, STS and post-phenomenology have developed a rich vocabulary and heuristics, including entanglement, human-machine unions, and incorporation. Although this conceptual vocabulary is very important for understanding how the technologically transformed body comes into being and is enacted in everyd...

New technologies produce new sensory experiences. This claim is perhaps revealed most vividly when people with implantable defibrillators endure the shocks these devices give to intervene in life-threatening heart-rhythm disturbances to help prevent a sudden cardiac arrest. Because ICD shocks may happen anywhere, understanding the techno-geography...

Although there exist high expectations and promises about what pacemakers and ICDs can do, technologies, like humans, can fail. These implants not only contribute to solving heart-rhythm problems, thus reducing the vulnerability of wired heart cyborgs, but may also introduce new vulnerabilities. Building resilience thus becomes a key concern for pe...

Pacemakers and ICDs can best be considered as devices that are embedded in a techno-geography of care: the working of these implants depends on situated care acts, which are dispersed over different spaces and involve a (re)distribution of tasks and responsibilities. One of the spaces that matter in enhancing the material resilience of wired heart...

conceptualizing the active engagement of everyday cyborgs in building resilience as work;

This book examines how pacemakers and defibrillators participate in transforming life and death in high-tech societies. In both popular and medical accounts, these internal devices are often portrayed as almost magical technologies. Once implanted in bodies, they do not require any ‘user’ agency. In this unique and timely book, Nelly Oudshoorn argu...

Science, Technology, and Society - edited by Todd L. Pittinsky November 2019

Technologies inside bodies pose new challenges in a technological culture. For people with pacemakers and defibrillators, activities such as passing security controls at airports, using electromagnetic machines, electrical domestic appliances and electronic devices, and even intimate contacts with their loved ones can turn into events where the pro...

This article adopts an intersectional approach to investigate how age, gender, and diversity are represented, silenced, or prioritized in design. Based on a comparative study of design practices of information and communication technologies (ICTs) for young girls and older people, this article describes differences and similarities in the ways in w...

This article contributes to Science and Technology Studies on vulnerability by putting cyborgs at center stage. What vulnerabilities emerge when technologies move under the skin? I argue that cyborgs face new forms of vulnerability because they have to live with a continuous, inextricable intertwinement of technologies and their bodies. Inspired by...

While many technology assessments (TAs) formally conducted by TA organizations in Europe and the USA have examined the implications of new technologies for ‘quantifiable risks’ regarding safety, health or the environment, they have largely ignored the ethical implications of those technologies. Recently, ethicists and philosophers have tried to fil...

An important aim of telecare technologies for chronic patients is supporting self-management. Although patient involvement is crucial for successful implementation, any adaptation of telecare systems to needs of users requires explicit reflection regarding which form of self-management it should support. Scenario-based methods (SBDs) are proposed t...

Recently there has been a renewed interest in cyborgs, and particularly in new and emerging fusions of humans and technologies related to the development of human enhancement technologies. These studies reflect a trend to follow new and emerging technologies. In this article, I argue that it is important to study older' and more familiar cyborgs as...

In Surveillance Studies the terms 'sousveillance' and 'inverse surveillance' describe forms of surveillance that have a bottom-up and democratic character. However, in this paper this democratic notion is questioned by looking into practices and experiences with both Closed Circuit Television (CCTV) and mobile cameras by Dutch citizens. By interven...

Dominant discourses on telecare technologies often celebrate the erasure of distance and place. This paper provides a critical intervention into these discourses by investigating how spaces still matter, despite the move from physical to virtual encounters between healthcare professionals and patients. I argue that science and technology studies (S...

Wi-Fi has become the preferred means for connecting to the internet – at home, in the office, in hotels and at airports. Increasingly, Wi-Fi also provides internet access for remote communities where it is deployed by volunteers in community-based networks, by operators in ‘hotspots' and by municipalities in ‘hotzones'. This book traces the global...

Technological devices can do and mean a lot. My argument throughout this book has been that telecare technologies cannot be considered as isolated instruments that can simply be implemented and diffused in healthcare without changing the order of care and what care is all about. The previous chapters have illustrated how telecare technologies parti...

Technologies cannot exist without promises. Biographies of technologies are therefore fascinating to read because they often describe expectations and promises that are no longer part of our collective memory or else have become part and parcel, the ‘essence’, of the technology as we know it today. Although promises thus may come and go, they are n...

Telecare technologies affect healthcare in a very profound way: they transform its spatial dimensions. Patients no longer have to visit the hospital or the general practitioner’s consulting rooms frequently and doctors do not have to pay regular visits to patients’ homes to diagnose and monitor chronic diseases because interactions are mediated by...

Telecare technologies drastically transform the order of who cares. As described in the first chapter, major parts of healthcare are delegated to patients. Instead of passive recipients, they are expected to become active and responsible participants in the diagnosis and monitoring of health disorders. In the changing landscape of healthcare, patie...

The discourses on telecare described in the previous chapter reflect not only a reductionist view of healthcare; they also rely on a rather restricted view of technology. Actors with vested interests in the promotion of telecare technologies consider these innovations as problem solvers: telecare devices are expected to make healthcare more efficie...

Technical devices are intriguing objects. Advocates of new technologies often try to convince us that technologies will solve of society problems and improve our lives. This view of technology as problem-solver also dominates discourses on telecare technologies. As described in the previous chapter, telecare devices are expected to solve financial...

Since the late nineteenth century patients have become accustomed to visiting hospitals or the general practitioner when they are in need of care. For chronic patients these visits have become part and parcel of their life; because there is no cure for their diseases, they depend on regular consultations with healthcare professionals to adjust medi...

When Mr X was diagnosed with heart failure, he felt depressed. He knew something was wrong because he was always so tired and short of breath when he did the usual things around the house. But he thought only elderly people would get this disease and he was only 57! Since the diagnosis, he feels rather useless because he also had to stop working. H...

Acknowledgements Introduction Who Cares? Theorizing Technology and the Transformation of Healthcare PART I: REORDERING CARE Promises, Scenarios and Silences Resistances and Boundary Work PART II: CREATING NEW FORMS OF CARE Telecare Workers: The Invisible Profession How Places Matter in Healthcare: Physical and Digital Proximity PART III: REDEFINING...

Introduction In this third chapter on the broader perspectives of the Wi-Fi innovation journey, the role of the user in community-based innovation is studied in detail. The domain of information and communication technologies has become one in which the boundaries between producers and users have become increasingly fuzzy. The availability of free...

The introduction of telehealth-care technologies profoundly changes existing practices of care. This paper aims to enhance our understanding of these changes by providing a comparative study of health-care services for heart-failure patients based on face-to-face contacts in a policlinic (department of a health care facility treating outpatients) a...

The role of users in innovation processes has gained increasing attention in innovation studies, technology studies, and media studies. Scholars have identified users and use practices as a source of innovation. So far, however, little insight has been generated in innovation processes in which communities of users are the driving force in all phas...

Although patients are often absent in discourses on telemedicine, many telemonitoring applications constitute a new medical practice in which patients are expected to play an active role. The paper is based on a study of the use of one specific telemonitoring device, an ambulatory ECG recorder introduced to diagnose infrequent irregularities of the...

The role of users in innovation processes has gained increasing attention in innovation studies, technology studies, and media studies. Scholars have identified users and use practices as a source of innovation. So far, however, little insight has been generated in innovation processes in which communities of users are the driving force in all phas...

In order to understand the constraints and challenges of realizing the democratic potentials of the Internet, this paper focuses on the attempts of three Dutch patient organizations to develop health websites. The authors describe how these patient organizations had to overcome specific barriers to develop their digital services. All three organiza...

div>Though the old saying claims that man is the measure of all things, the authors of Inside the Politics of Technology argue that the distinction implied between autonomous humans and neutral instruments of technology is an illusion. On the contrary, the technologies humans create simultaneously shape humans themselves. By means of case studies...

Based on two case studies of the design of electronic communication networks developed in the public and private sector this article explores the barriers within current design cultures to account for the needs and diversity of users. Whereas the constraints on usercentered design are usually described in macrosociological terms, in which the user...

Since the 1960s, the predominance of modern contraceptive drugs for women has disciplined men and women to delegate responsibilities for contraception largely to women. Consequently, contraceptive use came to be excluded from hegemonic masculinity. The weak alignment of contraceptive technologies and hegemonic masculinities constitutes a major barr...

Es war einmal eine Zeit, da war das Leben zumindest für WissenschaftstheoretikerInnen ziemlich einfach. Seit der Aufklärung wurde im Allgemeinen angenommen, dass “a progressive growth of scientific knowledge will uncover the natural order of things” (Smart 1992). In dieser modernistischen Philosophie bestanden unmittelbare Schnittstellen zwischen W...

In the early 1980s, my feminist friends repeatedly asked me to explain what biologists have had to say about women, and why it is that women are depicted as determined and limited by their "biological nature" in ways that men, in general, are not. Despite my years of education in biology, I had no answers to their questions. These questions led me...

This paper concerns a comparison of risk assessment practices of contraceptives for women and men. Our analysis shows how the evaluation of health risks of contraceptives does not simply reflect the specific effects of chemical compounds in the human body. Rather, we show how side-effects were rated differently according to the risk model that was...

In this paper, we describe an exhibition on gendered artifacts we have organized in the Netherlands and Norway. The major aim of the exhibition was to show the public the ways in which technical objects are inscribed with gender; this in order to make people aware that we live in a technological and gendered culture. Reflecting on our experiences w...

In diesem Buch wollte ich aufzeigen, dass Sexualhormone nicht einfach in der Natur gefunden werden. Ich wollte der herkömmlichen Auffassung, dass die Konzentration der Hormonforschung auf den Frauenkörper die natürliche Ordnung der Dinge widerspiegelt, eine andere Erklärung entgegensetzen. Beyond the Natural Body demonstriert, wie wissenschaftliche...

ICT is een belangrijk instrument voor de realisering van maatschappelijke doelstellingen. Ze maakt het mogelijk kleinschalige dienstverlening te organiseren binnen een grootschalige ondersteuningsstructuur. Zelfsturing van die kleinschalige dienstverleningsorganisatie is mogelijk binnen strakke kaders die centraal geformuleerd worden. Daarnaast is...

Since the 1970s cooperation between universities and pharmaceutical firms is business as usual. This has not always been the case. The first alliances between academic scientists and the pharmaceutical industry can be traced back to the 1920s. Compared to the U.S. and most other European countries, the creation of networks between the Dutch academy...

In the last fifteen years, testing has attracted much attention in science and technology studies. Most researchers have focused almost exclusively on testing in the laboratory, specifically designed test locations, and, for medical technologies, the clinic. What counts as testing has largely been described in terms of the activities of scientific...

This article analyses the social shaping of the Digital City of Amsterdam (DDS) from a gender perspective. It aims to contribute to an understanding of the overwhelming dominance (more than 90 per cent) of male DDS users, a fact which is more than surprising given that the designers had high ideals about making the internet accessible to a wider pu...

On hormones, technologies and bodies. An archeology of sex hormones 1923-1940. N. Oudshoorn. Nowadays, we can hardly imagine a world without hormones. Women all over the world take hormonal pills to control their fertility and estrogen and progesterone have become the most widely used drugs in the history of medicine. But why has the female rather...

When we talk about drug development we are inclined to think of the pharmaceutical industry, which has played a dominant role in research and development of drugs. Most modern prescription drugs have been developed by pharmaceutical companies in the Western industrialized world1 (Djerassi 1970, p. 943). However, industry is not the only actor in dr...

Over the last three decades the menopause has continued to interest the medical profession, the pharmaceutical industry and the mass media. Although there exist many different views on the menopause, there is one common denominator. Menopause is depicted as an exclusively female condition. The medical discourse on menopause seems to exclude men. Ho...

Studies of laboratory work have rarely focused on the role of intermediary organizations in developing R&D activities. Most studies focus on a single university-based research laboratory or an industrial R&D unit. Moreover the rejection by social constructivist scholars of universalistic, deterministic explanations of the development of science and...

Ver voor het begin van onze jaartelling, in de Griekse cultuur, gingen denken en genezen hand in hand. Denkers in die tijd waren erop uit een 'algehele heelkunde' voor de mens te ontwerpen; het accent lag op de continuïteit tussen lichaam en geest. De zorg voor zichzelf was een belangrijke notie voor de Grieken. Hierbij ging het erom te zoeken naar...

During this century the issue of homosexuality has been a recurrent theme on the research agenda of biologists. Historically, the life sciences have conceptualized homosexuals as persons with characteristics of the opposite sex. This paper discusses how the discourse on homosexuality became entangled with the discourse on gender.

Studies of drug development have described the role of clinical trials in the selection of drug profiles. This article presents a case study of the development of hormonal drugs in the 1920s and 1930s to illustrate that clinical trials have a more extensive role than is assumed. Clinical trials are instrumental in mediating the relationships betwee...

In the last decades the subject of sex hormones has intruded into the lives of many women, not only by the introduction of hormonal contraceptives but also by creating the image of the hormonal woman. Biology tells us that our preference for dolls or cars, our sexual orientation, and even our career choice is “all in our hormones.” In the early dec...

Studies of the creation of networks in science have rarely focused on the role of research materials in establishing relations between actors. This paper considers the question of how scientists' changing needs for research materials in the study of sex hormones, which emerged as a new field of the life sciences at the turn of the century, shaped b...

In two villages in the vicinity of Schiphol airport the consumption of certain drugs was studied over the years 1967–1974 by means of purchase data of the pharmacies. The drugs studied were hypnotics, sedatives, antacids (on prescription) and cardiovascular drugs. One of the villages had no serious problem with aircraft noise; the other village ini...