The politics of valuation and payment for regenerative medicine products in the UK

The field of regenerative medicine (RM) faces many challenges, including funding. Framing the analysis in terms of institutional politics, valuation studies and ‘technologies of knowledge’, the paper highlights growing debates about payment for RM in the UK, setting this alongside escalating policy debates about ‘value’. We draw on interviews and publicly available material to identify the interacting and conflicting positions of institutional stakeholders. It is concluded that while there is some common ground between institutional stakeholders such as industry and health system gatekeepers, there is significant conflict about reward systems, technology assessment methodologies and payment scenarios; a range of mostly conditional payment schemes and non-mainstream routes are being experimented with. We argue that current developments highlight a fundamental conflict between a concern for the societal value of medical technologies in a resource-limited system and a concern for engineering new reward and payment models to accommodate RM innovations

De l'inefficacité du réseau social : des liens sociaux non mobilisés chez les patients atteints de cancer

International audienceDe nombreuses études sur les réseaux sociaux portent sur la question des ressources auxquelles un individu peut avoir accès à travers ses relations sociales. En s'intéressant aux réseaux qui ont « fonctionné », elles tentent alors de spécifier les facteurs ayant permis l'accès aux ressources. Mais peu de travaux se sont penchés sur les réseaux ayant échoué à fournir à l'individu le bien ou le service qu'il recherchait. Cet article se propose de discuter de ces réseaux « inefficaces » à travers le cas de patients atteints de cancer recherchant des informations relatives à leur pathologie. Les résultats indiquent que les causes de l'inefficacité du réseau sont à rechercher dans la non mobilisation des liens de la part des malades rencontrés. Un certain nombre de contraintes pèsent sur ces liens empêchant ainsi leur mobilisation

How should we set consumption thresholds for low risk drinking guidelines? Achieving objectivity and transparency using evidence, expert judgement and pragmatism

Most high-income nations issue guidelines on low-risk drinking to inform individuals' decisions about alcohol consumption. However, leading scientists have criticized the processes for setting the consumption thresholds within these guidelines for a lack of objectivity and transparency. This paper examines how guideline developers should respond to such criticisms and focuses particularly on the balance between epidemiological evidence, expert judgement and pragmatic considerations. Although concerned primarily with alcohol, our discussion is also relevant to those developing guidelines for other health-related behaviours. We make eight recommendations across three areas. First, recommendations on the use of epidemiological evidence: (1) guideline developers should assess whether the available epidemiological evidence is communicated most appropriately as population-level messages (e.g. suggesting reduced drinking benefits populations rather than individuals); (2) research funders should prioritize commissioning studies on the acceptability of different alcohol-related risks (e.g. mortality, morbidity, harms to others) to the public and other stakeholders; and (3) guideline developers should request and consider statistical analyses of epidemiological uncertainty. Secondly, recommendations to improve objectivity and transparency when translating epidemiological evidence into guidelines: (4) guideline developers should specify and publish their analytical framework to promote clear, consistent and coherent judgements; and (5) guideline developers' decision-making should be supported by numerical and visual techniques which also increase the transparency of judgements to stakeholders. Thirdly, recommendations relating to the diverse use of guidelines: (6) guideline developers and their commissioners should give meaningful attention to how guidelines are used in settings such as advocacy, health promotion, clinical practice and wider health debates, as well as in risk communication; (7) guideline developers should make evidence-based judgements that balance epidemiological and pragmatic concerns to maximize the communicability, credibility and general effectiveness of guidelines; and (8) as with scientific judgements, pragmatic judgements should be reported transparently