Alberto Ardissone, L’uso delle tecnologie in sanità. Il punto di vista del paziente cronico, Angeli, 2018
10.6092/issn.2038-3460/17499
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2038-3460
17499
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Alberto Zanutto
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Tecnoscienza – Italian Journal of Science & Technology Studies
Alberto Ardissone, The use of technology in healthcare. The point of view of the chronic patient, Angeli, 2018
Text.Serial.Journal
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Book Reviews
2021-11-01
2023-06-27
2021-11-01
2023-10-19
123-127
TS
Alberto Zanutto
2021/11/01
10.6092/issn.2038-3460/17499
123
Università di Verona
2038-3460
1
en
127
Alberto Ardissone, The use of technology in healthcare. The point of view of the chronic patient, Angeli, 2018
https://tecnoscienza.unibo.it/article/download/17499/16344
12
Book Reviews                                                              123
    Alberto Ardissone
L’uso delle tecnologie in sanità. Il punto di vista del paziente cronico. [The
use of technology in healthcare. The point of view of the chronic patient],
Milano, Angeli, 2018, pp. 206

Alberto Zanutto Università di Verona

    As Tecnoscienza’s readers will know, the theme of the relationship be-
tween technology and health has been an important issue for a long time.
The theme is characterized by its breadth and the many implications that
health has in daily life. We have become increasingly aware of this relation-
ship during the Covid-19 pandemic that has transformed everything: work,
relationships, well-being, economy, international relations, even the wars
active around the globe.
    Alberto Ardissone explores the relationship between health and tech-
nology, as well as an array of connected complexities, observed in the pre-
Covid-19 period. He focuses particularly on the choices of patients with
respect to the search for information about their health through the Inter-
net. The topic has become relevant in recent years to understand how peo-
ple’s awareness changes in relation to the possibility of exploring their own
health thanks to blogs, peer groups, second opinions, tips about medicinal
drugs, informal chat about health and much more.
    The book is divided into two parts.
    The first part focuses on an analysis of Internet access and citizens’/pa-
tients’ health information. The second part describes the results of research
conducted online on a variety of Facebook groups attended by chronic pa-
tients and concerning specific diseases.
    In the first part, the book acknowledges the importance of the Internet
for the contemporary era and defines a series of opportunities and com-
plexities that this exposure to digital information can assume for patients
suffering from chronic pathologies.
    This massive exposure to the Internet is impressive for its rapid devel-
opment and for the potential it can offer to citizens/patients, but at the
same time it also defines a progressive loss of organizational boundaries as
well as those between public and private life. This description is followed
by a presentation of some theoretical lines of enquiry that the author con-
siders central for analysing the context of digital health.
    The author introduces a review of sociological theorizations that allow
him to grasp/study technological development in relation to the role of cit-
izens/patients. He distinguishes between the techno-supportive ap-
proaches whose points of synthesis can be found in the label of “patient
empowerment”, and the conflict-symbolist approaches whose gaze focuses
on the limits of the rationalist approach.
124                                                         Tecnoscienza – 12 (1)

    The first branch of approaches is defined in relation to "techno-eu-
phoric" analysis that emphasize the triggering role of technology in devel-
oping patients’ knowledge and ability to take care of their health needs.
The goal of economic savings and (estimated) improvement in the quality
of health services certainly stand out among these approaches. Thus, the
reference to the “empowerment” becomes a passepartout that will help
patients to increasingly improve their knowledge and their ability to inter-
act competently and appropriately with their own bodies. This is even
more true with respect to the ability to manage one's own health needs
starting from the vast amounts of health data that are increasingly available
and shareable.
    The other areas of approaches include interactionist, culturalist and
constructivist views exploring new complexities for health and well-being.
Among these, the author includes the contributions of critical sociology,
specifically the socio-material approach that connotes Science and Tech-
nologies Studies (STS). Through a quote from Lupton (2014, 610) it is re-
called how “technologies are defined as material actors in relation to hu-
man actors whose outcome results in a plurality of assemblages between
humans and technologies for an infinite combination of material and non-
material, of human and non-human” (p. 32). A brief section seeks to reit-
erate the role of this approach in understanding technology-patient inter-
actions in healthcare. It has been crucial in recent years to recognize the
processes of co-construction of technologies in healthcare by reclaiming
the temporariness of the balances that this relationship manifests. The ref-
erence to STS goes so far as to include the latest labels by Lupton (2017)
that focus on the definition of “affective atmosphere”, an expression that
wants to emphasize the intimate value that can be generated in this rela-
tionship. Or even referring to other Lupton's works the author recalls the
pervasiveness of human-non-human interaction that now seems to unite
many experiences through various types of wearables.
    Another window on critical approaches is reserved for the concept of
bio-politics that defines the weight of political power to every aspect of
human life, recalling in it the pervasiveness of market logics in every social
sphere. This approach indicates how the stimulus and marketing policies
aimed at the proper management of one's own health should be considered
as an extension of the influence of neoliberalism that pushes patients to
consider themselves customers and to become entrepreneurs of their own
health.
    In addition, the book includes among these approaches a reference to
the “surveillance society” by which attention is directed to the increasing
penetration into daily life of the technologies and practices needed to rec-
ord, probe, monitor, and discipline people's behaviour.
    A final section of approaches to the study of digitisation is reserved for
interactionist perspectives that draw their inspiration from Goffman's
Book Reviews                                                                 125
work. This view, the author reminds us, is very useful to recall the com-
plexity that is generated between the standardisation processes of central-
ised and unifying procedures of digitisation systems compared to the spec-
ificity of individuals, their clinical histories, and their representation of the
state of well-being and illness.
     At the end of this review of approaches, Ardissone proposes an "inte-
grated" approach aimed at grasping the multifaceted viewpoints required
when dealing with a complex issue such as digitisation in health care. He
promises to draw on these points of view in the research to follow.
     The research presented relies on a survey conducted with over 2,000
patients/citizens in Italy. The research aim was to offer at least three dif-
ferent layers of analysis: the socio-demographic characteristics of these us-
ers; the trust they place in the apps aimed at the Facebook group’s chronic
diseases; and, finally, the intent of those who turn to the Internet to find
information related to their particular health condition.
     The results of the survey help us to understand how the Internet is a
“particular” gateway. The data shows that more educated people look
more carefully at the sites of medical societies, while less educated people
look more widely at generic sites. The more educated show a greater inter-
est in being involved in decisions about their own health. Age seems to
influence mainly the demand for "second opinions" and more generally to
be more active in these types of groups. With regard to the gender of the
respondents, the research confirms that it is women who want more com-
prehensive information and prefer the websites of scientific societies, while
men choose their own sources quite indifferently. The research then devel-
ops through a series of elaborations proposing and/or recovering a series
of labels also discussed in the literature. For example, it highlights how
lurkers are mainly the most educated and the youngest in these thematic
groups.
     Among the results, it is worth mentioning the confirmation that the use
of specific apps for one's own chronic pathology – more prevalent for
males and younger people – allows patients/citizens better autonomy from
the dominance of specialists.
     Thus, the work developed in this book can be very useful in under-
standing some of the complexities of the relationship between the web and
the search for data related to one's own health by chronic patients, as well
as by family members who turn to the network to understand more about
the illnesses of their relatives/friends.
     The main path of exploration of the book is consistent and allows the
author to summarize approaches with a theoretical framework developed
in recent years concerning digitalization in healthcare. The book is also
characterised by being a tool for exploring the theme and a series of related
phenomena that are also characteristic of the Italian scene. Finally, among
the merits of the book we can certainly include the research, which in-
volved a large group of patients/citizens, representing members of about
126                                                          Tecnoscienza – 12 (1)

190 Facebook groups.
     Turning to the less successful parts of the book, we can first of all men-
tion the book’s title: The use of technology in healthcare. One of the risks
the reader might encounter is to expect coverage of the vast presence of
information technology in healthcare, which is of great interest in the field
of medical informatics, sociological, and sociotechnical approaches. In this
book, however, the idea is to explore the more specific phenomenology of
people who search for health information on the web and who, because
they are chronic patients, are interested in becoming more informed
through the experience of peer groups in order to share information to
improve their health conditions. Similarly, the extensive review of ap-
proaches to these issues presented in the first part seems only partially to
provide the specificity of interest that then emerges in the subsequent re-
search. On closer inspection, it is precisely the focus on technology and the
different ways of studying it that could perhaps have been better focused.
     At some point, the author argues that, “[c]onsequently, the technolog-
ical tools of e-Health and m-Health can be qualified as objects produced
in precise social, and therefore historical and geographical, contexts, incor-
porating cultures, needs, aspirations, choices, meanings, policies, con-
straints and potentials, merits and defects present in those societies. In this
way, we can study technologies by first considering their different natures”
(p. 41, my translation). This statement, among others, seems oriented to
restore a kind of static and non-processual idea of these technologies. As
recently recalled by Magaudda and Neresini (2020), the STS approach re-
quires considering technology, science, and the relationship with users as
a system of unstable equilibrium. For this reason, Ardissone’s work should
have considered, especially in the research chapters, getting closer to the
contexts in which the online data was accessed, the trajectories of use of
this data, which strategies and networks contributed to the production of
data in the different communities observed, what caught the attention of
group members, and the reasons for this interest.
     The symbolic side of such access is well-documented by the research
and analysis carried out, but for instance on the point of how technology
enters the care processes, imposing its rules and constraints, cannot be
solved only by identifying who uses apps or wearables.
     STS studies, among others, have shown in recent years that the contexts
of health service delivery generate a multiplicity of interpretations and dif-
ferent ways of using technologies (Crabu 2016). In Italy, for example, the
telemonitoring service for cardiology chronicity is differentiated region by
region and very often integrated by private remote monitoring and some-
times relying on general practitioners. The latter are included among the
figures of reference in the survey but without defining a specific section on
them to understand, for example, how their role enters into the manage-
ment of chronicity and the management of information related to chronic-
ity.
Book Reviews                                                                     127
    At the same time, the inclusion of technology in care processes asks us
to take note of the need to recognise the agency of technologies and the
political dimension of their existence among us in a plurality of “political”
arenas that are far from stable and homogeneous.
    Despite these aspects, it is important to acknowledge the book's efforts
in exploring the topic in a very broad manner and it has the merit of adding
interesting descriptions to the search for health data on the Internet by
chronic patients. The digitization processes in healthcare in Italy are still in
their infancy. Hopefully, the contributions of those exploring these topics
will increase. At the same time, we hope that awareness will increase about
how STS sensitivity can provide interesting research questions to under-
stand these emerging phenomena.

References
Crabu, S. (2016) Dalla molecola al paziente: La biomedicina nella società contem-
       poranea, Bologna, Il Mulino.
Lupton D. (2014) Apps as artefact: towards a critical perspective on mobile health
      and medical apps, in “Societies”, 4(4), pp. 606-622.
Lupton, D. (2017) How does health feel? Towards research on the affective atmos-
      pheres of digital health, in “Digital Health”, 3, pp. 1-11.
Magaudda, P. and Neresini, F. (eds.) (2020) Gli studi sociali sulla scienza e la tec-
      nologia, Bologna, Il Mulino.



                                        ***
   Barbara Czarniawska and Tor Hernes (eds.)
Actor-Network Theory and Organizing (2nd edition), Lund, Studentlitter-
atur, 2020, pp. 392

Bethan Mitchell Bath Spa University

    This second edition of Actor-Network Theory and Organizing has
been updated from the original version fifteen years previously. The book
comprises a variety of chapters that draw from Actor-Network Theory
(ANT) ideas and tenets, situated in organizational learning and Science
and Technology Studies. There are sixteen chapters, most of which
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