Islam, assisted reproductive technology and the politics of emergence: When markets and hegemonies collide.

The engagement between markets and cultural hegemonies is shaped by the politics that promote or deny the emergence of fresh legitimations in response to the opportunities offered to consumers by new commodities. In the case of Islam and the assisted reproductive technology (ART) market, core cultural values concerning procreation, family and lineage come into direct conflict with the potential consumer demand generated by new ART technologies. Shaped by the character of multiple Islamic modernities and the authority structures of religion and state, it is the Shi'a-Sunni divide which most illuminates the politics of emergence driving the different Islamic responses to those cultural tensions.

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.

The politics of ageing: health consumers, markets and hegemonic challenge.

In recent years ageing has travelled from the placid backwaters of politics into the mainstream of economic, social and cultural debate. What are the forces that have politicised ageing, creating a sustained opposition to the supply side hegemony of pharmaceuticals, medicine and state which has historically constructed, propagated and legitimised the understanding of ageing as decline in social worth? In addressing this question, the paper develops Gramsci's theory of hegemony to include the potentially disruptive demand side power of consumers and markets. It shows how in the case of ageing individuals acting in concert through the mechanisms of the market, and not institutionalised modes of opposition, may become the agents of hegemonic challenge through a combination of lifecourse choice and electoral leverage.

When a private community neurology practice executes home sleep apnea testing: benefits identified and lessons learned in a retrospective observational study.

Objective: To investigate the feasibility and utility of a private community neurology practice-initiated home sleep apnea testing (HSAT) program.

Methods: A private community neurology practice conducted HSAT on patients clinically identified as high risk for obstructive sleep apnea (OSA). An academic board-certified sleep specialist performed all study interpretations.

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, and the value of bioinformatics lies in its role 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.

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.

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

The 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.

Health consumers and stem cell therapy innovation: markets, models and regulation.

Global health consumer demand for stem cell therapies is vibrant, but the supply of treatments from the conventional science-based model of innovation is small and unlikely to increase in the near future. At the same time, several models of medical innovation have emerged that can respond to the demand, often employing a transnational value chain to deliver the product. Much of the commentary has approached the issue from a supply side perspective, demonstrating the extent to which national and transnational regulation fails to impose what are regarded as appropriate standards on the 'illicit' supply of stem cell therapies characterized by little data and poor outcomes.

Anticipatory Governance: Bioethical Expertise for Human/Animal Chimeras.

The governance demands generated by the use of human/animal chimeras in scientific research offer both a challenge and an opportunity for the development of new forms of anticipatory governance through the novel application of bioethical expertise. Anticipatory governance can be seen to have three stages of development whereby bioethical experts move from a reactive to a proactive stance at the edge of what is scientifically possible. In the process, the ethicists move upstream in their engagement with the science of human-to-animal chimeras.

Bioethical ambition, political opportunity and the European governance of patenting: the case of human embryonic stem cell science.

Scientific progress in the life sciences is dependent on the governance of tensions between the economic potential of the innovation and the cultural response from society. Ownership of the scientific innovation through patenting is a necessary part of the realization of its economic value yet, in the case of human embryonic stem cell (hESC) science, ownership of the human body and human life may offend fundamental cultural values. In the case of transnational patenting governance by the European Patent Office (EPO) and the European Union (EU), cross-national cultural conflict in the field of hESC science has produced a political demand for a form of governance that can incorporate ethical as well as economic judgements in its decision making.

Governing the moral economy: animal engineering, ethics and the liberal government of science.

The preferred Western model for science governance has come to involve attending to the perspectives of the public. In practice, however, this model has been criticised for failing to promote democracy along participatory lines. We argue that contemporary approaches to science policy making demonstrate less the failure of democracy and more the success of liberal modes of government in adapting to meet new governance challenges.

The current state of GMO governance: are we ready for GM animals?

Given the history of GMO conflict and debate, the GM animal future is dependent on the response of the regulatory landscape and its associated range of interest groups at national, regional and international levels. Focusing on the EU and the USA, this article examines the likely form of that multi-level response, the increased role of cultural values, the contribution of new and existing interest groups and the consequent implications for the commercialization of both green and red GM animal biotechnology.

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

Background: '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.

Regenerative medicine in Europe: global competition and innovation governance.

Leading European nations with strong biotech sectors, such as the UK and Germany, are investing heavily in regenerative medicine, seeking competitive advantage in this emerging sector. However, in the broader biopharmaceutical sector, the EU is outperformed by the USA on all metrics, reflecting longstanding problems: limited venture capital finance, a fragmented patent system, and relatively weak relations between academia and industry. The current global downturn has exacerbated these difficulties.

Proceeding carefully: assisted human reproduction policy in Canada.

The Canadian Act Respecting Assisted Human Reproduction and Related Research (AHR Act), which came into effect in 2004, was the culmination of fifteen years of policy development in this often controversial field. Drawing from a series of semi-structured elite interviews and extensive documentary research, we examine the path to policy for the AHR Act. We identified several influences on the Act's development, including: (1) feminist-informed activism which found a balance between rejecting the medical model of reproduction and instituting protections against the commodifying potential of reproductive technologies; (2) Canada's proximity to the United States (and its contrasting structures and stances); (3) the role of professional elites in supporting or resisting the proposed regulations; and (4) the tensions between federal and provincial jurisdiction in the Canadian federalist state.

Competition and compromise in negotiating the new governance of medical performance: the clinical governance and revalidation policies in the UK.

This article explores the development of two policies for the governance of medical performance in the UK: the Department of Health's (DH) clinical governance policy and the medical profession's revalidation policy. After discussing the institutional context in which each of these policies emerged, we examine how and why they were constructed. While the clinical governance policy was in large part a swift reaction to high-profile cases of medical misconduct in the late 1990s, revalidation was the profession's response to the politicisation of its self-regulatory apparatus.

Stem cell innovation in the USA: the benefits of the minimal state.

Stem cell science is an emerging global industry in which nation states compete fiercely for economic advantage. Currently, the USA dominates this international competition but critics have argued that it lacks an innovation strategy to maintain its position. Strong international competition and internal policy problems may pose significant challenges to the future of US stem cell science.

Patenting, morality and human embryonic stem cell science: bioethics and cultural politics in Europe.

As the recent experience of the European Patent Office graphically demonstrates, there is an inherent political tension between the individual ownership rights necessary for the operation of an international market in human embryonic stem cell science and the communal values of the many cultures in which such markets operate. This report examines the basis of the conflict between patenting and morality at national and international levels, the manifestation of those tensions in European patenting policy, and the contribution of bioethics to the attempt by European institutions to develop a governance response.

Stem cell science in India: emerging economies and the politics of globalization.

The globalization of stem cell science is increasingly being shaped by the emerging economies of the Asia/Pacific region. Undaunted and unhampered by the more established views of the commercialization of science, countries such as India are constructing models of innovation, policies and patterns of investment that challenge such orthodoxies. This report examines the position of India within the globalization of stem cell science, its adjustments to the developing knowledge market in this field and its particular contribution to the likely future of this promising bioeconomy.

China and the global stem cell bioeconomy: an emerging political strategy?

There is a growing consensus, amongst policy analysts and scientists alike, that China is likely to play a key role in the scientific, clinical and commercial development of stem cell research. However, to date, there exist few detailed analyses of China's current investment in the field. After introducing the UK's recent political strategy on stem cell science, this article develops an in-depth discussion of the formal organization of China's research and development in the area, as well as its rapidly evolving commercial, regulatory and ethical environment.

Governing UK medical performance: a struggle for policy dominance.

In the UK, policy on the governance of medical performance is characterised by a continuing struggle between state and profession for control of the agenda setting, formation and implementation stages of the policy process. Since 1998 both sides have continued to produce policies in response to highly visible political pressures but have yet to agree on how those policies should engage as they are implemented at the level of the individual practitioner. For the state, clinical governance forms the lynchpin of its drive to increase managerial control over doctors and, for the profession, revalidation is seen as the means for ensuring the quality of medical performance whilst preserving medicine's historic autonomy.

Psychosis in Parkinson's disease: case studies.

Psychosis is common in patients who have PD and leads to significant disability. Patients often can be managed with non-pharmacologic interventions or with decreasing doses of anti-parkinsonism medications. If these interventions are insufficient, then atypical antipsychotics should be considered.

Ocular Myasthenia Gravis.

Myasthenia gravis (MG) is an autoimmune disorder characterized clinically by proximal weakness and bulbar symptoms and pathologically by damage to the post-synaptic membrane at the neuromuscular junction. Ocular myasthenia gravis (ocular MG) is a form of myasthenia gravis whereby the patients' weakness is limited to the muscles of the eyes and eyelids (levator palpebrae superioris). Although not life-threatening, the limitations posed by ocular myasthenia gravis can prove disabling and distressing to patients.

The governance of human genetics: policy discourse and constructions of public trust.

The collection of practices now commonly understood as 'biotechnology' poses a challenge to traditional mechanisms of regulating science and technology, just as it challenges traditional practices of science. The task of regulation is to reconcile the often conflicting political demands of protecting science, economy and the public interest. Public trust is the key measure of political success or failure.