Islam, assisted reproductive technology and the politics of emergence: When markets and hegemonies collide

The engagement between markets and cultural hegemonies is shaped by the politics that promote or deny the emergence of fresh legitimations in response to the opportunities offered to consumers by new commodities. In the case of Islam and the assisted reproductive technology (ART) market, core cultural values concerning procreation, family and lineage come into direct conflict with the potential consumer demand generated by new ART technologies. Shaped by the character of multiple Islamic modernities and the authority structures of religion and state, it is the Shi'a-Sunni divide which most illuminates the politics of emergence driving the different Islamic responses to those cultural tensions. In Sunni states the hegemonic challenge of the ART commodity market is contained by the senior clerics, the traditional intellectuals of Islamic authority, often acting in concert with the state apparatus. In contrast, in Shi'a states the flexibility of its religious authority structures underpinned by the principles of ijtihad allows the formation of an alliance between traditional and medical organic intellectuals which facilitates the consumer choice of both ART commodities and legitimating values. However, what remains unresolved is the long-term impact of that trasformismo on the stability of the social structures which the Shi'a moral economy serves.

Constructing healthcare services markets: networks, brokers and the China-England engagement

BACKGROUND

Healthcare services is an expanding international market with which national healthcare systems engage, and from which they benefit, to greater and lesser degrees. This study examines the case of the China-England engagement in healthcare services as a vehicle for illuminating the way in which such market relationships are constructed.

FINDINGS

China and England have different approaches to the international healthcare services market. Aware of the knowledge and technology gaps between itself and the leading capitalist nations of the West in healthcare, as in other sectors, the Chinese leadership has encouraged a variety of international engagements to facilitate the bridging of these gaps including accessing new supply and demand relationships in international markets. These engagements are situated within an approach to health system development based on establishing broad policy directions, allowing a degree of local innovation, initiating and evaluating pilot studies, and promulgating new programmatic frameworks at central and local levels. The assumption is that the new knowledge and technologies are integrated into this approach and implemented under the guidance of Chinese experts and leaders. England's healthcare system has the knowledge resources to provide the supply to meet at least some of the China demand but has yet to develop fully the means to enable an efficient market response, though such economic engagement is supported by the UK's trade related departments of state. As a result, the development of China-England commercial relationships in patient care, professional education and hospital and healthcare service development has been led largely by high status NHS Trusts and private sector organisations with the entrepreneurial capacity to exploit their market position. Drawing on their established international clinicians and commercial teams with experience of domestic private sector provision, these institutions have built trust-based collaborations sufficiently robust to facilitate demand-supply relationships in the international healthcare services market. Often key to the development of relations required to make commercial exchange feasible and practicable are a range of international brokers with the skills and capacity to provide the necessary linkage with individual healthcare consumers and institutional clients in China. Integral to the broker role, and often supplied by the broker itself, are the communication technologies of telemedicine to enable the interaction between consumer and healthcare provider, be this in patient care, professional education or healthcare service development.

CONCLUSIONS

Although England's healthcare system has the knowledge required to respond to China's market demand and such economic engagement is supported and actively encouraged by the UK's trade related departments of state, the response is constrained by multiple domestic demands on its resources and by the limits of the NHS approach to marketisation in healthcare.

The politics of ageing: health consumers, markets and hegemonic challenge

In recent years ageing has travelled from the placid backwaters of politics into the mainstream of economic, social and cultural debate. What are the forces that have politicised ageing, creating a sustained opposition to the supply side hegemony of pharmaceuticals, medicine and state which has historically constructed, propagated and legitimised the understanding of ageing as decline in social worth? In addressing this question, the paper develops Gramsci's theory of hegemony to include the potentially disruptive demand side power of consumers and markets. It shows how in the case of ageing individuals acting in concert through the mechanisms of the market, and not institutionalised modes of opposition, may become the agents of hegemonic challenge through a combination of lifecourse choice and electoral leverage. In response, the hegemony is adapting through the promotion of professionally defined interpretations of 'active ageing' designed to retain hegemonic control. With the forces of hegemony and counter-hegemony nicely balanced and fresh issues such as intergenerational justice constantly emerging, the political tensions of ageing are set to continue.

Controlling new knowledge: Genomic science, governance and the politics of bioinformatics

The rise of bioinformatics is a direct response to the political difficulties faced by genomics in its quest to be a new biomedical innovation, and the value of bioinformatics lies in its role as the bridge between the promise of genomics and its realization in the form of health benefits. Western scientific elites are able to use their close relationship with the state to control and facilitate the emergence of new domains compatible with the existing distribution of epistemic power - all within the embrace of public trust. The incorporation of bioinformatics as the saviour of genomics had to be integrated with the operation of two key aspects of governance in this field: the definition and ownership of the new knowledge. This was achieved mainly by the development of common standards and by the promotion of the values of communality, open access and the public ownership of data to legitimize and maintain the governance power of publicly funded genomic science. Opposition from industry advocating the private ownership of knowledge has been largely neutered through the institutions supporting the science-state concordat. However, in order for translation into health benefits to occur and public trust to be assured, genomic and clinical data have to be integrated and knowledge ownership agreed upon across the separate and distinct governance territories of scientist, clinical medicine and society. Tensions abound as science seeks ways of maintaining its control of knowledge production through the negotiation of new forms of governance with the institutions and values of clinicians and patients.

Bioinformatics and the Politics of Innovation in the Life Sciences: Science and the State in the United Kingdom, China, and India

The governments of China, India, and the United Kingdom are unanimous in their belief that bioinformatics should supply the link between basic life sciences research and its translation into health benefits for the population and the economy. Yet at the same time, as ambitious states vying for position in the future global bioeconomy they differ considerably in the strategies adopted in pursuit of this goal. At the heart of these differences lies the interaction between epistemic change within the scientific community itself and the apparatus of the state. Drawing on desk-based research and thirty-two interviews with scientists and policy makers in the three countries, this article analyzes the politics that shape this interaction. From this analysis emerges an understanding of the variable capacities of different kinds of states and political systems to work with science in harnessing the potential of new epistemic territories in global life sciences innovation.

Hegemony in the marketplace of biomedical innovation: consumer demand and stem cell science

The global political economy of stem cell therapies is characterised by an established biomedical hegemony of expertise, governance and values in collision with an increasingly informed health consumer demand able to define and pursue its own interest. How does the hegemony then deal with the challenge from the consumer market and what does this tell us about its modus operandi? In developing a theoretical framework to answer these questions, the paper begins with an analysis of the nature of the hegemony of biomedical innovation in general, its close relationship with the research funding market, the current political modes of consumer incorporation, and the ideological role performed by bioethics as legitimating agency. Secondly, taking the case of stem cell innovation, it explores the hegemonic challenge posed by consumer demand working through the global practice based market of medical innovation, the response of the national and international institutions of science and their reassertion of the values of the orthodox model, and the supporting contribution of bioethics. Finally, the paper addresses the tensions within the hegemonic model of stem cell innovation between the key roles and values of scientist and clinician, the exacerbation of these tensions by the increasingly visible demands of health consumers, and the emergence of political compromise.

Health consumers and stem cell therapy innovation: markets, models and regulation

Global health consumer demand for stem cell therapies is vibrant, but the supply of treatments from the conventional science-based model of innovation is small and unlikely to increase in the near future. At the same time, several models of medical innovation have emerged that can respond to the demand, often employing a transnational value chain to deliver the product. Much of the commentary has approached the issue from a supply side perspective, demonstrating the extent to which national and transnational regulation fails to impose what are regarded as appropriate standards on the 'illicit' supply of stem cell therapies characterized by little data and poor outcomes. By contrast, this article presents a political economic analysis with a strong demand side perspective, arguing that the problem of what is termed 'stem cell tourism' is embedded in the demand-supply relationship of the health consumer market and its engagement with different types of stem cell therapy innovation. To be meaningful, discussions of regulation must recognize that analysis or risk being sidelined by a market, which ignores their often wishful thinking.

Anticipatory Governance: Bioethical Expertise for Human/Animal Chimeras

The governance demands generated by the use of human/animal chimeras in scientific research offer both a challenge and an opportunity for the development of new forms of anticipatory governance through the novel application of bioethical expertise. Anticipatory governance can be seen to have three stages of development whereby bioethical experts move from a reactive to a proactive stance at the edge of what is scientifically possible. In the process, the ethicists move upstream in their engagement with the science of human-to-animal chimeras. To what extent is the anticipatory coestablishment of the principles and operational rules of governance at this early stage in the development of the human-to-animal research field likely to result in a framework for bioethical decision making that is in support of science? The process of anticipatory governance is characterised by the entwining of the scientific and the philosophical so that judgements against science are also found to be philosophically unfounded, and conversely, those activities that are permissible are deemed so on both scientific and ethical grounds. Through what is presented as an organic process, the emerging bioethical framework for human-to-animal chimera research becomes a legitimating framework within which 'good' science can safely progress. Science gives bioethical expertise access to new governance territory; bioethical expertise gives science access to political acceptability.

Governing the moral economy: animal engineering, ethics and the liberal government of science

The preferred Western model for science governance has come to involve attending to the perspectives of the public. In practice, however, this model has been criticised for failing to promote democracy along participatory lines. We argue that contemporary approaches to science policy making demonstrate less the failure of democracy and more the success of liberal modes of government in adapting to meet new governance challenges. Using a case study of recent UK policy debates on scientific work mixing human and animal biological material, we show first how a ‘moral economy’ is brought into being as a regulatory domain and second how this domain is governed to align cultural with scientific values. We suggest that it is through these practices that the state assures its aspirations for enhancing individual and collective prosperity through technological advance are met.

State strategies of governance in biomedical innovation: aligning conceptual approaches for understanding 'Rising Powers' in the global context

Background

'Innovation' has become a policy focus in its own right in many states as they compete to position themselves in the emerging knowledge economies. Innovation in biomedicine is a global enterprise in which 'Rising Power' states figure prominently, and which undoubtedly will re-shape health systems and health economies globally. Scientific and technological innovation processes and policies raise difficult issues in the domains of science/technology, civil society, and the economic and healthcare marketplace. The production of knowledge in these fields is complex, uncertain, inter-disciplinary and inter-institutional, and subject to a continuing political struggle for advantage. As part of this struggle, a wide variety of issues - regulation, intellectual property, ethics, scientific boundaries, healthcare market formation - are raised and policy agendas negotiated.

Methods

A range of social science disciplines and approaches have conceptualised such innovation processes. Against a background of concepts such as the competition state and the developmental state, and national innovation systems, we give an overview of a range of approaches that have potential for advancing understanding of governance of global life science and biomedical innovation, with special reference to the 'Rising Powers', in order to examine convergences and divergences between them. Conceptual approaches that we focus on include those drawn from political science/political economy, sociology of technology; Innovation Studies and Science & Technology Studies. The paper is part of a project supported by the UK ESRC's Rising Powers programme.

Results

We show convergences and complementarities between the approaches discussed, and argue that the role of the national state itself has become relatively neglected in much of the relevant theorising.

Conclusions

We conclude that an approach is required that enables innovation and governance to be seen as 'co-producing' each other in a multi-level, global ecology of innovation, taking account of the particular, differing characteristics of different emerging scientific fields and technologies. We suggest key points to take account of in order in the future to move toward a satisfactory integrative conceptual framework, capable of better understanding the processes of the emergence, state steerage and transnational governance of innovative biomedical sectors in the Rising Powers and global context.

Regenerative medicine in Europe: global competition and innovation governance

Leading European nations with strong biotech sectors, such as the UK and Germany, are investing heavily in regenerative medicine, seeking competitive advantage in this emerging sector. However, in the broader biopharmaceutical sector, the EU is outperformed by the USA on all metrics, reflecting longstanding problems: limited venture capital finance, a fragmented patent system, and relatively weak relations between academia and industry. The current global downturn has exacerbated these difficulties. The crisis comes at a time when the EU is reframing its approach to the governance of innovation and renewing its commitment to the goal of making Europe the leading player in the global knowledge economy. If the EU is to gain a competitive advantage in the regenerative medicine sector then it must coordinate a complex multilevel governance framework that encompasses the EU, member states and regional authorities. This article takes stock of Europe’s current competitive position within the global bioeconomy, drawing on a variety of metrics in the three intersecting spheres of innovation governance: science, market and society. These data then provide a platform for reviewing the problems of innovation governance faced by the EU and the strategic choices that have to be confronted in the regenerative medicine sector.

Proceeding carefully: assisted human reproduction policy in Canada

The Canadian Act Respecting Assisted Human Reproduction and Related Research (AHR Act), which came into effect in 2004, was the culmination of fifteen years of policy development in this often controversial field. Drawing from a series of semi-structured elite interviews and extensive documentary research, we examine the path to policy for the AHR Act. We identified several influences on the Act's development, including: (1) feminist-informed activism which found a balance between rejecting the medical model of reproduction and instituting protections against the commodifying potential of reproductive technologies; (2) Canada's proximity to the United States (and its contrasting structures and stances); (3) the role of professional elites in supporting or resisting the proposed regulations; and (4) the tensions between federal and provincial jurisdiction in the Canadian federalist state. The path to this outcome provides an illuminating study of the tensions between internal and external pressures in the policy process.

A proto-type design of a real-tissue phantom for the validation of deformation algorithms and 4D dose calculations

The purpose of this study is to design a real-tissue phantom for use in the validation of deformation algorithms. A phantom motion controller that runs sinusoidal and non-regular patient-based breathing pattern, via a piston, was applied to porcine liver tissue. It was regulated to simulate movement ranges similar to recorded implanted liver markers from patients. 4D CT was applied to analyze deformation. The suitability of various markers in the liver and the position reproducibility of markers and of reference points were studied. The similarity of marker motion pattern in the liver phantom and in real patients was evaluated. The viability of the phantom over time and its use with electro-magnetic tracking devices were also assessed. High contrast markers, such as carbon markers, implanted in the porcine liver produced less image artifacts on CT and were well visualized compared to metallic ones. The repositionability of markers was within a measurement accuracy of +/-2 mm. Similar anatomical patient motions were reproducible up to elongations of 3 cm for a time period of at least 90 min. The phantom is compatible with electro-magnetic tracking devices and 4D CT. The phantom motion is reproducible and simulates realistic patient motion and deformation. The ability to carry out voxel-based tracking allows for the evaluation of deformation algorithms in a controlled environment with recorded patient traces. The phantom is compatible with all therapy devices clinically encountered in our department.