De/Prescribing Matters: Ecologies of Prescribing and Deprescribing in Science and Technology Studies

The great majority of retail pharmaceuticals are prescription-only drugs, making prescriptions a prevalent, widespread, and powerful technology in healthcare. In this chapter, we provide a comprehensive review of the vast social science literature on prescriptions and de/prescribing. We argue that closer attention to what we call “ecologies of de/prescribing” allows us to consider de/prescribing as situated and distributed practices that are intimately embodied, materially grounded, and embedded in interdependent relations of power. The ecological lens foregrounds the historical, social, political, and economic interrelations in which de/prescribing takes place. It also invites an understanding of prescriptions and prescribing as sites of power and agency in global pathways of pharmaceutical care, as well as ever more fragile ecosystems. We suggest that future STS engagements with de/prescribing should take into account its mundane administration, pressing concerns of the Anthropocene, global pathways of pharmaceutical care, digital transformations, the (re)production of inequalities through large-scale prescription infrastructures and markets, as well as the largely overlooked issue of more-than-human de/prescribing.