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Health care systems all over the world are undergoing rapid and profound transformations. These changes are the result of a broad array of economic and social trends including neo-liberal economic policies that are contributing to the trend toward privatization, the commodification of health services and products, institutional restructuring (e.g., managed care) to contain costs in the context of technological advances, globalization and demographic changes such as population aging in post-industrial societies. Questions about the accessibility and quality of health care delivery in the face of persistent health disparities, growing numbers of medical errors, and new and uncertain risks posed by emerging infectious diseases, some of them drug-resistant, have also contributed to rethinking about health policy.

Purpose – This chapter explores the pharmaceutical industry's strategic utilization of empowerment discourse in two realms: direct-to-consumer advertising (DTCA) and clinical drug development.

Methodology – It draws upon two research projects that examine the role of the pharmaceutical industry in the political economy of healthcare in the United States: Ronald's policy analysis and participant observation of DTCA policy hearings and Fisher's participant observation and interviewing of the clinical trials industry.

Findings – Empowerment rhetoric is mobilized by the pharmaceutical industry to create specific expectations about patient-consumer behavior, particularly the responsibilities associated with the consumption of drugs.

Research implications – The social and economic implications of DTCA and drug trials must be understood within their broader historical and contemporary contexts of health advocacy, consumerism, and medical neoliberalism.

Practical implications – The chapter offers alternative constructions of healthcare subjects and pharmaceutical practices that can mitigate the power of the pharmaceutical industry and bring about better pharmaceutical governance.

Originality/value of chapter – By analyzing findings from two empirical projects, this chapter is able to shed light on trends in the pharmaceutical industry's discourse about empowerment and consumption from the clinical testing to marketing of new drugs.

Purpose – This research considers how self-help groups (SHGs) and self-help organizations (SHOs) contribute to consumerist trends in two different societies: United States and United Kingdom. How do the health care systems and the voluntary sectors affect the kinds of social changes that SHGs/SHOs make?

Methodology/approach – A review of research on the role of SHGs/SHOs in contributing to national health social movements in the UK and US was made. Case studies of the UK and the US compare the characteristics of their health care systems and their voluntary sector. Research reviews of two community level self-help groups in each country describe the kinds of social changes they made.

Findings – The research review verified that SHGs/SHOs contribute to national level health social movements for patient consumerism. The case studies showed that community level SHGs/SHOs successfully made the same social changes but on a smaller scale as the national movements, and the health care system affects the kinds of community changes made.

Research limitations – A limited number of SHGs/SHOs within only two societies were studied. Additional SHGs/SHOs within a variety of societies need to be studied.

Originality/value of chapter – Community SHGs/SHOs are often trivialized by social scientists as just inward-oriented support groups, but this chapter shows that local groups contribute to patient consumerism and social changes but in ways that depend on the kind of health care system and societal context.

Purpose – This chapter examines medical consumerism and the changing relations between patients as consumers and the medical system across two women's health contexts, breast cancer and infertility.

Methodology/approach – The analysis draws on two qualitative studies: The first explores the experiences of 60 breast cancer survivors through in-depth interviews and participant observation (Sulik, 2005), and the second uses in-depth interviews to analyze 18 women's experiences with infertility (Eich-Krohm, 2000).

Findings – The medical consumer is an individualized role that shifts attention away from the quality problem in health care and toward the quality of the person as a medical consumer who is characterized to be optimistic, proactive, rational, responsible, and informed.

Research limitations/implications – As medicine has become a form of mass consumption, the category of medical consumer has elevated the individual in medical decision-making. The shift from patient to medical consumer is an ongoing process that is grounded in a tension between medical control and individual agency, and is exacerbated by the intensity and incomprehensibility of modern medicine.

Practical implications – The proliferation of medical information and personal illness narratives through the Internet, advice books, and self-help groups have advanced lay knowledge about preventive medicine and medical treatment while simultaneously introducing new fears and anxiety about the multitude of options and outcomes.

Originality/value of chapter – This study contributes to our knowledge on medical consumerism and its impact on illness experience and the synthesis of lay and professional knowledge.

Purpose – Recent research on the modes of patient activism has displaced older notions of patients as passive, compliant subjects of biomedical power. This chapter expands analyses of patient activism to examine the intersections between the processes of identity formation, the emergence of a new scientific field (human stem cell research), and political institutions.

Methodology – This chapter uses in-depth interviews, ethnographic techniques, and textual analyses to collect data regarding California's 2004 ballot initiative, Proposition 71, The California Stem Cell Research and Cures Act. Data were analyzed using a situational analysis approach. Situational analysis is a variant of grounded theory that organizes data in the form of maps of connections between actors and social worlds.

Findings – This chapter examines the content and significance of this event through the construction of a collective identity among supporters of Proposition 71, what I call “stem cell activists.” The construction of this collective identity serves as an important ground from which individuals and groups carve out political claims of self-representation. Stem cell activists also helped pass a controversial initiative through the efforts in publicly supporting Prop 71 and human stem cell research.

Research limitations – This research is limited in that it only examined individuals who became stem cell activists, and not individuals from whom this identity failed to gain salience. More research is needed to understand the conditions under which this identity becomes incorporated within a person's political repertoire.

Value of chapter – This chapter brings together theoretical perspectives on the symbolic aspects of identity construction and the political economy of biomedical science. This chapter will be of interest to scholars in medical sociology, science and technology studies, and social movement researchers.

Purpose – This chapter assesses the role of self-help groups within the emerging civil society in two transitional economies, Croatia and Slovenia, focusing on the impact of relationships with health or social care professionals and the state.

Methodology – Methods include participant observation, interviews, and document analysis of 31 groups studied intermittently from 2001 to 2007.

Findings – Self-help groups range from those three decades old to those dealing with “new social problems.” Groups, and the third sector generally, remain essentially dependent on the state. Few exist separately from formal service organizations. Those closely linked with medical institutions are challenged by state retrenchment and privatization. Others contend with funding instability, and Western models of non-profit development are expanding. Relationships with professionals are neither subservient nor independent; instead, groups act as corollaries and educators to the professional realm.

Implications, limitations, and value – Findings suggest more nuances in self-help groups' relations with the state and professionals than found in Western settings. This may illustrate both the potential and the limits of citizen involvement in new non-governmental sectors. It also demonstrates how relations between professionals and self-help groups depend on social and material relations well beyond the domain of systems of care. While specific findings cannot be generalized beyond the research settings, the study shows the importance of understanding such groups within social and political contexts. Contributions to civil society here included re-making public meanings, identities, and relations with professionalized systems. Further comparative assessment of self-help associations is essential to theory on the third sector in civil society.