Making HPV vaccines efficient: Cost-Effectiveness Analysis and the Economic Assemblage of Healthcare in Colombia (2017-07-11)
Cost-effectiveness analysis (CEA) is a strategy of calculation whose main objective is to compare for making decisions about the best, the most efficient solution (costs vs. benefits) to a particular problem. Cost-effectiveness analysis not only provides a framework to compare healthcare interventions which in practice seem incommensurable; it also performs a set of assumptions regarding the nature of healthcare and the behaviour of individuals. This article analyses the role of CEA as a device to produce value in the introduction of HPV vaccines in Colombia. In the different institutional pathways and decision-making scenarios cost-effectiveness has been the key issue that justified the inclusions and the exclusions that such technology entails. Cost-effectiveness has justified the definition of girls as the population target and the exclusion of boys from risks and benefits of this technology. Moreover, cost-effectiveness analysis has been a key instrument in the sexualising and de-sexualising of cervical cancer and HPV vaccines through the rationalisation of economic benefits.
Domesticating In Home Displays in Selected British and Norwegian Households (2017-07-07)
The paper uses qualitative data from Norway and the United Kingdom to understand the new technology of In Home Display monitors as a material object loaded with meaning and norms that may affect social practices and relations. The displays are designed to encourage householders to reduce electricity consumption. In contrast to technologies associated with ‘smart meters’, the monitors under study cannot be used for controlling or automatising various types of electricity consumption, but these devises nonetheless often form part of ‘smart grid solutions’. A large part of the research in this area has attempted to quantify the impact of displays, and qualitative research focusing on the users has also mainly sought to explain why - or why not – the introduction of displays has resulted in reduced household consumption. This paper follows a more open approach to the introduction and impact of displays by paying attention to the existing routines and social practices into which the display enters and potentially becomes integrated and domesticated. We examine to what extent ideas and norms inscribed in the display continue to have a bearing on the household moral economy and internal dynamics as the objects are negotiated and taken in use in British and Norwegian homes. Drawing on earlier studies that have sought to combine practice and domestication theory for understanding displays, the study’s novelty lies in its focus on the materiality of displays and social implications thereof, and its analysis of the social status of this object in two different contexts.
Speaking for Nature: Hobbes, Latour, and the Democratic Representation of Nonhumans (2017-05-10)
Environmental theorists have often considered how best to represent nature's interests. This essay develops an approach to the democratic representation of nonhuman nature by examining the relation between Bruno Latour’s account of representation and that of Thomas Hobbes. Both Hobbes and Latour develop a constructivist theory of representation as an ongoing process that partly constitutes what it represents. In this respect, Latour’s account complements the “constructivist turn” in recent democratic theory, and it suggests a promising avenue for representing nonhumans. However, Latour also follows Hobbes in viewing representation as a matter of unifying and replacing the represented. This aspect of Latour’s approach obscures certain key features of representative democracy in pluralist societies. The last part of the essay takes up an aspect of Hobbes’s theory neglected by Latour, the notion of “representation by fiction,” which suggests a way of representing nonhumans that offers more support for representative democracy than other approaches
Diplomacy in Action: Latourian Politics and the Intergovernmental Panel on Climate Change (2017-05-10)
The Intergovernmental Panel on Climate Change (IPCC) reviews scientific literature on climate change in an attempt to make scientific knowledge about climate change accessible to a wide audience that includes policymakers. Documents produced by the IPCC are subject to negotiations in plenary sessions, which can be frustrating for the scientists and government delegations involved, who all have stakes in getting their respective interests met. This paper draws on the work of Bruno Latour in order to formulate a so-called ‘diplomatic’ approach to knowledge assessment in global climate governance. Such an approach, we argue, helps to make climate governance more inclusive by helping to identify values of parties involved with the IPCC plenaries, and allowing those parties to recognize their mutual interests and perspectives on climate change. Drawing on observations during IPCC plenaries, this paper argues that a Latourian form of diplomacy can lead to more inclusive negotiations in climate governance
Scientific Performance Assessments Through a Gender Lens (2017-05-10)
The focus on excellence and quality assurance in the academy has spawned a significant increase in the use of bibliometric measures in performance assessments of individual researchers. This article investigates the organizational consequences of this development through a gender lens. Based on a qualitative case study of evaluation and selection practices at a Danish university, a number of potential gender biases related to the use of bibliometric performance measures are identified. By taking as default the research preferences, approaches and career paths of a succesful group of predominantly male scholars, evaluators using bibliometrics risk disadvantaging candidates diverging from the norm with implications for gender stratification. Despite these potential biases, bibliometric measures come to function as technologies supporting a managerial narrative of the gender-blind organization. They adhere to the prevailing ethos of the academic meritocracy by standardizing the criteria for organizational advancement and ensuring transparency and accountability in the selection process. While bibliometric tools in this sense may lead to the recruitment of scientists with a strong CV and track record, they may at the same time prevent many talented researchers diverging from the norm from being recognized and succeed as academics.
Diagnosing at Point of Care in South India (2017-07-07)
Point-of-care testing promises to cut diagnostic and treatment delays by ensuring patients receive a management decision based on a diagnostic test within one encounter with a provider. Adding to STS work on diagnostics and the sociology of diagnosis, this paper examines the work involved in enacting point-of-care testing, how technology features and the embedded assumptions regarding patients. Using focus group discussions with providers and patients in India, the results reveal overlaps, detours and frictions along diagnostic pathways. Diagnosing at point of care requires coordination work by providers and patients and alignment of diagnostic ensembles in which bodies, tools, knowledge, infrastructure, social relations and testing sites mutually configure each other. Patients do not always leave the point of care with one disease or diagnosis. In the process, they are both turned into objects as well as powerful actors. Contributions to STS theory and implications for global health innovation practices are discussed.
Making Room for Ethics (2017-07-11)
This article examines the work that goes in to ‘making room’ for ethics, literally and figuratively. It follows the activities of a capacity building Asia-Pacific NGO in training and recognising ethics review committees, using multi-sited field materials collected over 12 months between 2009 and 2010. Two queries drive this article: first, how are spaces made for ethical review –politically, infrastructurally, materially – as committee members campaign for attention to ethics and access to offices in which to conduct their meetings? Second, how are the limits of ‘local circumstance’ negotiated during a review of the committee’s work: what does the implementation of standards in the area of ethics look like? I then discuss what standards of ethics practice mean for more fraught questions of the universal in bioethics. Rather than regarding ethics systems as backgrounds to global health projects, this article’s STS and ethnographic approach reveals ethical review as a site of contested standardisation.
Bioinformatics imaginaries in the engine-room of genomic health policy (2017-05-10)
Bioinformatics comprises a diffuse field of technologies, knowledges, databases and software for medical and pharmaceutical innovation. It is becoming a major target of policymaking for global health goals, but experiences conflicts including over ownership and access; national versus commercial agendas; disease targeting; genomic versus clinical data. The paper draws on the political economy of states, and the performativity of policy and ‘sociotechnical imaginaries’ to identify diverging framings and imaginaries in a comparison of India and the UK. It argues that bioinformatics policies are diversified in India and increasingly co-ordinated in the UK; integration of clinical with genomic data is more prominent in the UK and more geared to hegemonic ‘platform’ technologies; India has more nation-focused, societal policy in disease strategies, and notable heterogeneity in the social production of genomic knowledge. The paper develops STS concepts by linking them to political state theory, highlighting social heterogeneity in technoscientific innovation.