Launch of the Health, Technology & Society Book Series, 25 October 2006: A Report
The Health, Technology and Society Book Series, published by Palgrave, got off to a flying start at an excellent launch event organised at the Royal Society in London. Delegates from academic, policy and political circles attended (see participants list below). Andrew Webster, co-editor with Sally Wyatt of the Series, opened the meeting with a brief review of the core themes (see here) that underpin the series and the books that had already been commissioned for it. He stressed the ways in which the Series explored the relationship between innovation, patient and practitioner engagement and the ways in which the new books will be able to open up debate around existing approaches towards the utility and value of new technologies.
Dr Louise Wood, Head of Innovation and Industry R & D Relations at the Department of Health , then gave the first main address of the meeting with a review and discussion of the Department’s strategy for health technology innovation. There are a range of mechanisms and structures that have been initiated over the past two years that are designed to improve the uptake of technology, but these are being driven by a much greater sense of what patients’ needs are. She argued that it is important for the DoH to develop new methodologies to determine the value of new medical technologies across the course of the patient’s ‘life-cycle’. The new Innovation and Training hubs that have been established are as much if not more about fostering a ‘technology pull’ approach that is informed by patient needs, and to be addressed by both mundane as well as high-tech innovation. In some cases, of course, these two go together: introducing health technologies into the home – the domestication of health innovation – often requires highly innovative ways of making them useable and mundane.
Further information can be found at the Healthcare Industries Task Force (HITF) and the National Institute for Health Research websites.
This focus on users, especially patients, was the theme of the second major presentation from our international guest, Professor Nelly Oudshoorn, Professor of Technology Dynamics and Healthcare at the University of Twente. Drawing on one of her most recent books (How Users Matter: The Co-Construction of Users and Technology, co-edited with Trevor Pinch) she spoke of the ways in which users co-produce technologies and make them workable, giving them their meaning and utility. But often this work is invisible to both designers and suppliers of healthcare innovation, as she illustrated most clearly in her discussion of telemedicine (here). Patients have to act as ‘active diagnostic agents’ for example in the use of home-based ECG devices where they must determine the ‘right moment’ to deploy the ECG, itself dependent on their own sense of their condition and how they ‘read’ their body. In addition, she showed how a range of social actors engage in articulation work to manage the consequences of the distribution of roles and responsibilities relating to the construction and use of a diagnosis. Nelly’s paper prompted considerable debate relating to the implications it has for healthcare, especially in regard to the need for policy and practice, to more readily acknowledge the invisible work that is attendant with new technologies, work which patients may in fact be reluctant to undertake. What then does this mean for patient-need and patient-centred care?
There followed a series of papers presenting outlines of those books that have already been contracted to the Series. John Abraham (Professor of Sociology at the University of Sussex) offered a review (here) of his book (co-authored with Courtney Davis) on the pharmaceutical industry and its regulation by agencies such as the EMEA and the FDA. He made a very forceful case for a critical realist approach to understanding the relationship between the actual effects of new drugs and the ways in which medicines are understood by patients, by regulators and the industry itself. The therapeutic value of drugs cannot simply be seen in terms of actors’ perceptions thereof nor indeed in terms of patients’ desires for new medicines, which may in fact work against their interests (so accelerated drug approvals to meet patient demand may well be open to question). He noted that over the past 15 years we have seen increasing international harmonisation but no effort to introduce comparative efficacy testing of drugs seeking approval from regulatory agencies. There has also been a reshaping of the evidence-base inasmuch as we have seen an increase in the degree to which surrogate markers are used to assess drug utility compared with the clinical evidence. He noted that there has been a decline in drugs innovation over the recent past which may well have counterproductive effects for regulatory innovation itself.
Gerard de Vries (Professor of Philosophy of Science and Technological Culture at the University of Amsterdam) presented a summary of the themes that inform his book, co-authored with Klasien Horstman, ‘Genetics: from lab to society’ (here). Their work explores the use of genetics tests in clinics and shows how we need to focus less on the test itself and more on the infrastructures and processes that tests involve: the work, time, uncertainty they invoke; the distribution and redistibution of responsibilities they are associated with; and broadly, the ways in which the search for certainty – a definitive genetic test – actually is generative of a good deal of uncertainty, such as when and how far the condition will kick-in, the differing views across clinicians, and the instability of tests themselves over time.
Alex Faulkner (from the School of Social Sciences, Cardiff University) explored the world of medical devices, to form the main focus of his book (here). He discussed the role of what he calls the ‘healthcare sciences’, those methodologies used to evaluate the utility of innovation, such as health technology assessment, which look at evidence of performance, advocacy, epidemiological need and so on. His book will tell the story of how a range of devices are subject to the process of ‘governation’ (not simply ‘governance’) by which he means the co-construction of value acoss a range of different agencies and social actors. The ‘devising of health’ charactersises much contemporary innovation especially in regard to the turn towards self-care and patient empowerment.
Carl May (Professor of Medical Sociology at the Centre for Health Services Research, University of Newcastle) provided a review (here) of his book which will lift the lid on HTA as a ‘proto-academic discipline’ found within the ‘evidence-based kitchen’. The age of evaluation is the age of methodologists, recruited to report how health innovations can be shown to be demonstrably useful through rigorous evidence-based procedures. We see now a cadre of researchers who act as outsourced civil servants working for an ‘evidence-informed state’. He argued that all of provisionality, and the the micropolitics and work behind the scenes of clinical trials are made invisible by RCTs and the discourse of evidence-based medicine. He suggested that there is a fetish for outcome studies in preference to process studies and so a failure to understand how to make new technologies workable, how they might be normalised and optimised within clinical and non-clinical settings.
Brian Salter (Director of the Global Biopolitics Research Group, University of East Anglia) described (here) the core themes of his book on global politics and embryonic stem cells research. His work will examine the ways in which cultural values are ‘traded’ politically across different countries as they seek to establish their regulatory approaches to regenerative medicine. The moral status of the embryo is subject to a diverse range of normativities that frame its ‘rights’ in quite distinctive ways. Yet national systems are cut across by globalised processes, not least by the drivers of scientific networks and commercial interests. Some countries, such as Germany, in allowing the procurment of outsourced stem cell lines, thereby outsource a moral dilemma that has caused major controversy in Germany itself. This ‘trading’ in cultural values works to create complex political, bioethical and economic networks at a global level. The book will provide a detailed analysis of these processes from the perspective of poltical science.
Finally, Steve Wainwright (from the Division of Health & Social Care Research, King's College London) gave a summary (here) of the book, ‘Body, Bio-medicine and Society’ (co-authored with Clare Williams). The book will explore organ transplantation, intensive care medicine and stem cell biology, three of the defining areas of innovative health technologies. He showed how these three biomedical realms require extensive collaboration between scientists and clinicians, making them particularly interesting fields for social research as they enable the fusion of science and technology studies (STS) with medical sociology. The four central chapters of the book will form a series of case studies which illustrate the fruitfulness of this blending of the literatures on the body, STS, and medical sociology, grounded in Steve and Clare’s ethnographic fieldwork on stem cells, laboratory life, intensive care medicine and organ transplants.
The closing session by Co-Editor to the Series, Sally Wyatt (from the Virtual Knowledge Studio, Royal Netherlands Academy for Arts and Sciences) drew out the cross-cutting overlaps among the papers presented during the day. She showed how the new Series would be of both analytical and policy importance to those working in the field of health innovation, medical sociology, and science and technology studies. There were a number of other books currently being considered for the Series and the hope is that some dozen or so books may eventually be published. This would provide the first, comprehensive range of material that deals with health, technology and society relationships to be published within the social sciences, and the support of Palgrave, and especially our commissioning Editor, Jill Lake, was noted with gratitude. Future books will be announced on the Series web page within Palgrave (see http://www.palgrave.com/products/Catalogue.aspx?is=1403991308) and on the York and Amsterdam sites.
Andrew Webster & Sally Wyatt, Series Editors.
Participants
Professor John Abraham, University of Sussex
Beth Allen, Royal Pharmaceutical Society
Professor Paul Atkinson, Cardiff University
Tom Barclay, The Genetic Interest Group
Professor Michael Bury, Royal Holloway, University of London
Dr Helen Busby, University of Nottingham
Professor Joan Busfield, University of Essex
Dr John Clegg, Department of Health
Brice Dattee, Imperial College London
Professor Gerard De Vries, University of Amsterdam
Dr Alex Faulkner, Cardiff University
Ingrid Geesink, Cardiff University
Professor Eileen Green, University of Teeside
Dr Evan Harris MP, House of Commons
Dr Andreas Hasman, Royal Pharmaceutical Society
Mrs Stephanie Hazel-Gant, Innovative Health Technologies Programme, Administrator
Dr Jane Hendy, Imperial College London
Professor Flis Henwood, University of Brighton
Professor Jenny Hewison, University of Leeds
Kerry Holden, King’s College London
Professor Klasien Horstman, University of Maastricht
Dr Julie Kent, University of the West of England
Kerstin Klein, London School of Economics
Jill Lake , Palgrave Macmillan
Professor Carl May, University of Newcastle upon Tyne
Linsey McGoey, BIOS, LSE
Dr Norma Morris, University College London
Caroline Mozley, North Yorkshire NHS R&D Alliance
Professor Anne Murcott , South Bank University
Doug NaysmithMP, House of Commons
Ann Noble, Ann Noble Architects
Professor Nelly Oudshoorn, University of Twente
Damian Pattinson, British Medical Journal
Professor Naomi Pfeffer, London Metropolitan University
Nicholas Robinson, NHS Direct
Professor Brian Salter, University of East Anglia
Professor Jane Sandall, King's College, London
Tanja Sinozic, University of Sussex
Caprice Sobels, Wellcome Trust
Dr Jonathan Suk, ESRC Genomics Policy and Research Forum
Dr Steve Wainwright, King's College London
Professor Andrew Webster, Innovative Health Technologies Programme, Director
Dr Catherine Will, University of Cambridge
Dr Clare Williams, King's College London
Dr Louise Wood, R&D Relations, Deptartment of Health
Dr Sally Wyatt, Virtual Knowledge Studio, KNAW
Dr Joy Zhang, London School of Economics