Mutual benefit, added value? Doing research in the National Health Service

The National Health Service (NHS) has recently been the focus of government efforts to retain pharmaceutical research in the UK. Efforts to foster new partnerships between health care providers and industry have been framed with suggestions that clinical trials can offer patient benefit within the NHS, cutting across ethical and sociological concerns with the possible tension between doing research and offering care. This paper draws on ethnographic research to explore the sometimes awkward juxtapositions between trial protocols and everyday care, individual health and commercial profit, and thus the distribution of value produced through trials. While researchers appear to find the distinction between research and care useful, at least some of the time, both formal and informal strategies for living with this distinction may have the unintended consequence of making research appear supplementary to rather than simply different from clinical care

The problem and the productivity of ignorance: public health campaigns on antibiotic stewardship

This article offers a critical account of efforts to engage people with the issue of antimicrobial resistance (AMR). It analyses how public health workers encourage what they understand as responsible antibiotic use or antibiotic stewardship, and how their efforts are shaped by different theories of ‘behaviour’ or social action. Discourse analysis of all major UK campaigns and their evaluations over the last two decades reveals how different versions of the citizen jostle for attention in a public health that draws on sociology, psychology, and increasingly behavioural economics. Rejecting an explanation which focuses solely on the appeal of emotion in new forms of governance, I deploy theories of expert and lay ignorance to show how public health is pushed towards new approaches as it struggles with an apparently recalcitrant public in the case of AMR. Here ignorance is both problematic and productive, prompting a shift to campaigns based on unreflective action, that are accompanied by decisions to work with potential misunderstandings about antibiotics and their effects. I suggest the term ‘shrug’ as a provocative counterpart to the ‘nudge’ of behavioural economics, drawing attention to the ways in which behavioural interventions may be linked to strategic retreats from engagement, when policy makers feel unable to affect or predict the understanding and views of non-experts. The article thus contributes to sociological and political critique of narrow forms of behavioural thinking and their effects on relations between governments and their citizens

‘And breathe…’? The sociology of health and illness in COVID-19 time

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Navigating standards, encouraging interconnections: infrastructuring digital health platforms

Apps, websites and networked devices now offer to help consumers produce, access and share health knowledge, precipitating social scientific concern over the consequences of these so-called digital health platforms. This paper makes a novel contribution to this literature, taking up a recent call from Plantin et al. to adopt an infrastructural lens in exploring platforms. It argues, through empirical analysis of digital health platforms of different sizes, ages and nationalities, that this conceptual tool is necessary to surface the work entailed in creating and sustaining digital health platforms. Additionally, we suggest that the social scientific literature on platforms–and initial efforts to explore their infrastructural qualities–frequently focus too strongly on the dominant technology companies. Instead, we emphasise the value of drawing emergent companies’ platforms into empirical purview through returning to some of the infrastructures literature that informs Plantin et al.–particularly Susan Leigh Star and colleagues. We demonstrate empirically the importance of looking at standards as part of infrastructure building, and the broader set of interconnections between different actors and materials within an infrastructure. In doing so, we demonstrate the value of an infrastructural lens for understanding the density of interconnections that characterise digital health and propose some orientating questions for further enquiry into the infrastructural qualities of platforms

Everyday curation? Attending to data, records and record keeping in the practices of self-monitoring

This paper is concerned with everyday data practices, considering how people record data produced through self-monitoring. The analysis unpacks the relationships between taking a measure, and making and reviewing records. The paper is based on an interview study with people who monitor their blood pressure and/or body mass index/weight. Animated by discussions of ‘data power’ which are, in part, predicated on the flow and aggregation of data, we aim to extend important work concerning the everyday constitution of digital data. In the paper, we adopt and develop the idea of curation as a theory of attention. We introduce the idea of discerning work to characterise the skilful judgements people make about which readings they record, how readings are presented, and about the records they retain and those they discard. We suggest self-monitoring produces partial data, both in the sense that it embodies these judgements, and also because monitoring might be conducted intermittently. We also extend previous analyses by exploring the broad set of materials, digital and analogue, networked and not networked, involved in record keeping to consider the different ways these contributed to regulating attention to self-monitoring. By paying attention to which data is recorded and the occasions when data is not recorded, as well as the ways data is recorded, the research provides specificity to the different ways in which self-monitoring data may or may not flow or contribute to big data sets. We argue that ultimately our analysis contributes to nuancing our understanding of ‘data power’

A Relook at Canada’s Western Canada Sedimentary Basin for Power Generation and Direct-Use Energy Production

The Alberta No. 1 Project, under the terms of Canada’s Federal government’s Emerging Renewable Power Program (ERPP), must produce 5MWe net. The goal of this study was to identify areas where three essential constraining conditions overlap; (1) the temperature gradient is sufficiently high that 120°C brines at depths of 4,500m or less are potentially available, (2) there are formations at the depths targeted with known high fluid flows, and (3) there is adequate existing infrastructure that supports low-cost power grid connection as well as a direct use application. A fluid temperature of at least 120oC is needed to profitably operate the plant. Temperatures below this require increasingly greater amount of fluids to be pumped and injected making them uneconomic. Three hundred liters per second (l/sec) of 120oC water is required to generate 5 MW net of electrical power with an Organic Rankin Cycle (ORC) binary plant. A depth cut off from a project economics perspective is about 4,500m for large diameter geothermal wells. Fortunately, these formations don’t need to be thick to supply these volumes of water to the well bore and thin permeable formations are expected to be laterally extensive in the regional layer cake (Western Canada Sedimentary Basin, WCSB) geology of Alberta. Thus, targeting known high fluid producing geologic units, rather than narrow faults is an important aspect of developing a geothermal project in the WCSB. Alberta No. 1 identified nine study areas to assess for geothermal potential. Of these, the Tri-Municipal Industrial Park (south of Grande Prairie) was determined to be the most suitable for both power production and development, followed by Edson (west-central Alberta). Other areas were identified as being most suitable for basement EGS to produce power, as well as direct use from shallower formations

Out of Our Heads! Four perspectives on the curation of an on-line exhibition of medically themed artwork by UK medical undergraduates

The Medical School at Bristol University is noted for offering, and in some instances requiring, its students to work creatively with medical themes. Students, artists, educationalists and a web designer have worked to create an on-line exhibition of the resulting creative output. This can be viewed at www.outofourheads.net. This site is a themed repository of poetry, prose, drawings, paintings, cartoons, films, music, dance and rap. Most works come with commentaries that can be as illuminating as the works they describe. The site invites comment and welcomes new postings from anyone connected to medicine. As an alternative to the conventional pedagogical report, and in keeping with the subject matter, in this paper we tell the story of this unique educational enterprise through the narratives of four of its principle architects. The ‘Teacher's Tale’, the ‘Designer's Tale’, the ‘Curator's Tale’ and the ‘Artist's Tale’ offer different, personal, tellings of how the site came to be. Each tale contains hypertext links to notable works on the site some of which have become teaching resources within the institution. This paper is of relevance to anyone who seeks to explore and champion the human insights of this privileged community

The drugs don't sell: DIY heart health and the over-the-counter statin experience

This paper draws on a study of over-the-counter statins to provide a critical account of the figure of the ‘pharmaceutical consumer’ as a key actor in the pharmaceuticalisation literature. A low dose statin, promising to reduce cardiovascular risk, was reclassified to allow sale in pharmacies in the UK in 2004. We analysed professional and policy debates about the new product, promotional and sales information, and interviews with consumers and potential consumers conducted between 2008 and 2011, to consider the different consumer identities invoked by these diverse actors. While policymakers constructed an image of ‘the citizen-consumer’ who would take responsibility for heart health through exercising the choice to purchase a drug that was effectively rationed on the NHS and medical professionals raised concerns about ‘a flawed consumer’ who was likely to misuse the product, both these groups assumed that there would be a market for the drug. By contrast, those who bought the product or potentially fell within its target market might appear as ‘health consumers’, seeking out and paying for different food and lifestyle products and services, including those targeting high cholesterol. However, they were reluctant ‘pharmaceutical consumers’ who either preferred to take medication on the advice of a doctor, or sought to minimize medicine use. In comparison to previous studies, our analysis builds understanding of individual consumers in a market, rather than collective action for access to drugs (or, less commonly, compensation for adverse effects). Where some theories of pharmaceuticalisation have presented consumers as creating pressure for expanding markets, our data suggests that sociologists should be cautious about assuming there will be demand for new pharmaceutical products, especially those aimed at prevention or asymptomatic conditions, even in burgeoning health markets