Biomedicalization has restructured the frame of health care through standardization of technoscientific biomedical processes that allow pharmaceutical managed care organization to create a transformative rhetoric within biomedicine. This justifies governmental control on the body concentrated on surveillance mechanism that hinges on medical classification as a form of biological reengineering from the inside out.

“Biomedicalization” has been used to explain a wide gamut of social phenomena, from specific diseases such as HIV and cardiovascular disease to overarching conditions such as mental and sexual health, as well as to life processes such as aging and dying and social characteristics such as race, gender, and sexuality. Researchers examining these phenomena have noticed the ways in which biomedicine has come to define them, casting such phenomena with a bioscientific imprimatur. The term “medicalization” was first introduced in the early 1970s to characterize the social process by which medicine increases its jurisdiction, entering into formerly nonmedical domains of life (Conrad 1975; Zola 1972). Theorists at the time trained their attention on the dominance of the medical profession, encouragement by social movements and patient advocacy groups, and changing institutional or organizational structures that supported the increasing reach of medicine. Yet by the turn of the Millennium, scholars were finding that medical authority wasn’t what it used to be, medicine itself was again restructuring in critical ways, and the forms that health organizing was taking were also changing drastically (Conrad 1992, Starr 2008). Due to government cost control measures and the success of social movements to create patient-based and holistic healthcare, the professional dominance of doctors was rapidly eroding. A corporate brand of managed care was taking the place of self-administered physicians networks. The pharmaceutical industry rushed in to sell drugs directly to managed care organizations and to patients themselves. Third-party payers also grew in influence, assuming a gatekeeping role in healthcare (Prainsack, this volume). The late 1990s was a critical time for medicine, as the world braced itself for the first mapping of the human genome. The Human Genome Project published a draft map in 2000, and medicine underwent a paradigm shift, becoming rationalized by bioscientific interests and aims (Clarke et al. 2010). A substantial biotechnology industry arose, replete with new, closer academic–industry relations and a growing market of direct-to-consumer goods. One major aspect of the new bioscientific medicalization, what Clarke et al. (2003: 162) summarize as “the increasingly complex, multisited, multidirectional processes of medicalisation that today are being both extended and reconstituted through the emergent social forms and practices of a highly and increasingly technoscientific biomedicine,” is economic restructuring toward the consolidation of a “biomedical technoservice complex.” This new system is characterized by multinational corporations and privatized rather than state-funded research and healthcare. Again, managed care systems have replaced physician-dominated systems. Meanwhile, increases in fee-for-service options and the devolution of healthcare management to individual patients, as well as new population-based practices that rely on new concepts of identity, have created a uniquely stratified form of medicalization. A second aspect of biomedicalization is a concerted focus on health, risk, and surveillance. Health has become a moral imperative, something individuals must work toward. Governments, medical organizations, and individuals themselves constantly monitor risks, and they do so in terms of genetic diagnoses and molecular categorizations. As Clarke et al. (2003: 172) note, “it is impossible not to be ‘at risk.’” Third, biomedicalization is characterized by a “technoscientization” of biomedicine, that is, a rationalization by technology and science at the same time. Processes and systems are computerized and standardized by new technologies and scientific classification systems. Healthcare is driven by evidence-based biomedicine, which is itself characterized by statistical reasoning and molecular science. A host of “Omic” sciences prevail, encouraging biological engineering “from the inside out” (Clarke et al. 2003: 176). Healthcare is delivered by way of electronic record systems, digitized biotechnologies, and bioengineered applications. Fourth, biomedicalization works by way of new transformations of information and the production and distribution of knowledges. Biomedicine dominates the media, where it dispels alternative notions of health and wellbeing and alternative systems of knowledge. Responsibility for one’s health is cast as an individual problem that is to be addressed with consumer applications. A range of cottage industries has cropped up offering consumers DIY (Do-It-Yourself ) goods and services, while health gurus and high-profile medical experts have encouraged patients to go online, self-diagnose, and purchase products. At the same time, pharmaceutical commercials and news of clinical trials trump alternative and complementary medicine, now joining with healthcare professionals and patient movements to popularize genetic tests and cures (Löwy, this volume). Finally, biomedicalization entails a transformation of bodies and identities. Biomedicalization is no longer about controlling a pathological entity, but rather hinges on customizing bodies to be the best they can be. There are two fundamental rhetorics, that of choice and lifestyle optimization. Individuals are pressed to opt for healthy behaviors and habits in their everyday lives, and to use biotechnologies to constantly monitor their improvement from moment to moment, in real time. Norms have multiplied such that there is no longer a singular definition of what it is to be “normal.” A plethora of identities have emerged, forged through the interaction with biotechnology and new medical classifications. Increasingly, identity is cast in genetic terms, and it is done so amid a global network that has important international ramifications (see Jingfeng in this volume). Medicalization theorists have debated whether these transformations warrant a shift in terminology (Conrad 2005; Rose 2007). Still, all agree that where medicalization occurs, it is unique in how it links up with processes like geneticization, molecularization, and pharmaceuticalization, the processes by which reductionist genetic explanations are used to describe differences between individual and group traits and behaviors (Lippman 1991), molecular models advance in science and society (Chadevarian and Kamminga 1998), and the way that conditions are transformed into opportunities for pharmacological interventions (Williams et al. 2011). Biomedicalization increasingly involves the redefinition of characteristics and conditions as inherently found in one’s DNA code and thus knowable and treatable by biomedicine, propels molecular models forward in the various fields and subfields of biomedicine as well as in healthcare and society, and bolsters pharmacological hegemony in the basic structures of bioscience and health delivery systems, often leading to an individualization of intervention and a depoliticization of care (Bell and Figert 2015).