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, its value being that it acts 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 benefit to occur and public trust to be assured, genomic and clinical data have to be integrated and knowledge ownership agreed 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

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

<p>Abstract</p> <p>Background</p> <p>'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.</p> <p>Methods</p> <p>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.</p> <p>Results</p> <p>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.</p> <p>Conclusions</p> <p>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.</p

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

AbstractThe 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

The increasingly global scope of the foreign corrupt practices act

El presente artículo analiza el desarrollo, las características y el alcance de la Ley de Prácticas Corruptas en el Exterior de los Estados Unidos y sus implicaciones en los actos ilegales en las organizaciones públicas y privadas estadounidenses y del resto del mundo, en el marco de un contexto de cooperación internacional, índices bursátiles y relaciones económicas globales. Se exponen diferentes casos y formas de actuar legal e ilegalmente en algunas organizaciones a partir de la normatividad analizada. El documento tiene un alto valor contextual para resaltar el papel de la contabilidad como soporte de actos ilegales y advierte sobre las implicaciones de actuar fraudulentamente cuando hay relaciones comerciales con empresas estadounidenses cubiertas con esta ley.This article analyzes the development, characteristics and scope of the Foreign Corrupt Practices Act of the United States and its implications for illegal acts in public and private organizations in the United States and the rest of the world, within the framework of a context of international cooperation, stock market indices and global economic relations. Different cases and ways of acting legally and illegally in some organizations are exposed based on the regulations analyzed. The document has a high contextual value to highlight the paper of accounting as a support for illegal acts and warns about the implications of acting fraudulently when there are business relationships with US companies covered by this law

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

On Bayesian Modelling of the Uncertainties in Palaeoclimate Reconstruction

We outline a model and algorithm to perform inference on the palaeoclimate and palaeoclimate volatility from pollen proxy data. We use a novel multivariate non-linear non-Gaussian state space model consisting of an observation equation linking climate to proxy data and an evolution equation driving climate change over time. The link from climate to proxy data is defined by a pre-calibrated forward model, as developed in Salter-Townshend and Haslett (2012) and Sweeney (2012). Climatic change is represented by a temporally-uncertain Normal-Inverse Gaussian Levy process, being able to capture large jumps in multivariate climate whilst remaining temporally consistent. The pre-calibrated nature of the forward model allows us to cut feedback between the observation and evolution equations and thus integrate out the state variable entirely whilst making minimal simplifying assumptions. A key part of this approach is the creation of mixtures of marginal data posteriors representing the information obtained about climate from each individual time point. Our approach allows for an extremely efficient MCMC algorithm, which we demonstrate with a pollen core from Sluggan Bog, County Antrim, Northern Ireland.Comment: 25 pages, 7 figure

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

Preferred treatment position between supine and prone for pelvic radiation therapy; quantification of the intrafractional body motion component by 3D surface imaging system

Purpose: We investigated the preferred treatment position between supine and prone during pelvic radiation treatment using real time tracking data from AlignRT. Our findings will provide valuable information regarding the role of intrafractional body motion in answering the question of prone versus supine position for pelvis radiation. Methods: Ten patients receiving pelvic radiation were enrolled in this study. For each patient, two simulation helical CT scans were performed, one in supine and one in prone position. Body surface contours were automatically generated and then exported to the AlignRT system as reference images. AlignRT continuous patient body motion tracking (1.5 to 2 minutes) was performed for both positions for each patient once per week for five weeks. The equivalent patient body motion along three principle directions was calculated from the six degree of freedom real time patient displacements data. The maximum and the standard deviation (STD) of equivalent patient body motion were calculated, so as the average of maximum and STD of equivalent patient motion over five fractions. These were then compared between supine and prone orientations. Results: A correlation was observed between the intrafractional body motion and large BMI. For overweight/obese patients, the intrafractional body motion was smaller for the supine position in both vertical and longitudinal directions. For normal range BMI patients, we observed no clear advantage for either supine or prone position in both vertical and longitudinal directions. In lateral direction, the intrafractional motion did not have statistically difference between two positions. Conclusion: Our study shows that the amount of intrafractional body motion between supine and prone orientation is correlated with patient BMI. Overweight/obese patients experienced significantly less overall body motion in supine orientation. The preferred treatment position for normal BMI patients was seen to be individually variable

The impact of the COVID-19 pandemic on an international rehabilitation study in MS: the CogEx experience

Pandemic restrictions have led to changes in therapy plans and disrupted rehabilitation services for people with multiple sclerosis. CogEx is an international, multicentre MS dual-intervention (cognitive rehabilitation, aerobic exercise) randomized, controlled rehabilitation trial confined to people with progressive disease. The primary outcome is cognition (processing speed).There are 11 treatment sites in six countries with participants required to make 27 site visits over 12 weeks. Collectively, the large, in-person demands of the trial, and the varying international policies for the containment of COVID-19, might disproportionately impact the administration of CogEx. During the first lockdown, all centres closed on average for 82.9 (SD = 24.3) days. One site was required to lockdown on two further occasions. One site remained closed for 16 months. Ten staff (19.2%) were required to quarantine and eight staff (15.4%) tested positive for COVID. 10 of 264 (3.8%) participants acquired COVID-19. All survived. The mean duration of enrollment delay has been [236.7 (SD = 214.5) days]. Restarting participants whose interventions were interrupted by the pandemic meant recalculating the intervention prescriptions for these individuals. While the impact of the pandemic on CogEx has been considerable, all study sites are again open. Participants and staff have shown considerable flexibility and resilience in keeping a complex, international endeavour running. The future in general remains uncertain in the midst of a pandemic, but there is cautious optimism the study will be completed with sufficient sample size to robustly evaluate our hypothesis and provide meaningful results to the MS community on the impact of these interventions on people with progressive MS. Trial registration: The trial was registered on September 20th 2018 at www.clinicaltrials.gov having identifier NCT03679468. Registration was performed before recruitment was initiated