Pharmacogenetics, controversies and new forms of service delivery in autoimmune diseases, acute lymphoblastic leukaemia and non-small-cell lung cancer

Pharmacogenetics (PGx) and personalised medicine are new disciplines that, gathering the existing knowledge about the genetic and phenotypic factors that underpin drug response, aim to deliver more targeted therapies that avoid the existing problems of adverse drug reactions or lack of drug efficacy. PGx and personalised medicine imply a shift in the way drugs are prescribed, as they require introducing diagnostic tools and implementing pre-screening mechanisms that assess patients' susceptibility to new or existing drugs. The direct benefit is an improvement in drug safety and/or efficacy. However, neither pharmacogenetics nor personalised medicine, are widely used in clinical practice. Both technologies face a number of controversies that hamper their widespread use in clinical practice. This thesis investigates the scientific; technological; social; economic; regulatory and ethical implications of PGx and personalised medicine, to understand the enablers and barriers that drive the process of technology diffusion in three conditions: autoimmune diseases, acute lymphoblastic leukaemia and non-small cell lung cancer.The thesis uses concepts of the sociology of science and a qualitative approach, to explore the arguments for and against the use of the technology by different actors (pharmaceutical and biotechnology companies, researchers, clinicians, regulators and patient organisations). The core of this analysis lies in the understanding of how, diagnostic testing (TPMT testing in the case of autoimmune diseases, acute lymphoblastic leukaemia, and EGFR testing in the case of non-small-cell lung cancer) may affect the existing drug development and service delivery mechanisms, with a particular focus on the user-producer interactions and feedback mechanisms that underpin diffusion of medical innovations and technological change in medicine.The thesis concludes by identifying gaps in knowledge and common issues among TPMT and EGFR testing, which might be used, in the future, to inform policy on how to improve PGx service delivery through a public Health System such as the NHS.EThOS - Electronic Theses Online ServiceManchester Institute of Innovation ResearchGBUnited Kingdo

Improving Distributed Intelligence in Complex Innovation Systems

Science and technology (S&T) are considered to be a central source, or at least a basic medium, of societal and industrial innovation, while innovation is conceived to basically feed the regeneration of our welfare. The suppliers of S&T in Europe as well as the users of their „products“, are confronted with a number of challenges today. We want to stress here that it was not the primary goal of our Advanced Science & Technology Policy Planning (ASTPP) Network to come up with proposals how the strategic character of European S&T policies could be strengthened. The ASTPP-network instead focuses on one aspect: the provision of strategic intelligence necessary to identify and develop strategic choices. The underlying hypothesis is that the existing body of experiences with technology foresight, technology assessment and S/T policy evaluation provides a basis for the development of an advanced S&T policy „planning“ approach by trying to enhance, interlink or even integrate the growing, but still dispersed experience in these three areas of intelligence. By „intelligent“ we mean that the inter-relatedness of S&T, industrial efforts, societal needs and political interventions becomes more transparent so that interactive collaboration between them will be facilitated

Improving Distributed Intelligence in Complex Innovation Systems

Science and technology (S&T) are considered to be a central source, or at least a basic medium, of societal and industrial innovation, while innovation is conceived to basically feed the regeneration of our welfare. The suppliers of S&T in Europe as well as the users of their „products“, are confronted with a number of challenges today. We want to stress here that it was not the primary goal of our Advanced Science & Technology Policy Planning (ASTPP) Network to come up with proposals how the strategic character of European S&T policies could be strengthened. The ASTPP-network instead focuses on one aspect: the provision of strategic intelligence necessary to identify and develop strategic choices. The underlying hypothesis is that the existing body of experiences with technology foresight, technology assessment and S/T policy evaluation provides a basis for the development of an advanced S&T policy „planning“ approach by trying to enhance, interlink or even integrate the growing, but still dispersed experience in these three areas of intelligence. By „intelligent“ we mean that the inter-relatedness of S&T, industrial efforts, societal needs and political interventions becomes more transparent so that interactive collaboration between them will be facilitated