The Three Rs of Fear Messaging in a Global Pandemic: Recommendations, Ramifications and Remediation.

INTRODUCTION: We consider the UK Independent Scientific Pandemic Insights Group on Behaviours' (SPI-B) support for fear messaging during the global COVID-19 pandemic, evaluate the consequences and make recommendations for the future. ANALYSIS: Using evidence from published documents, we show that SPI-B supported the use of fear messaging during the COVID-19 pandemic. This is inconsistent with the extant psychological literature and contrary to the disaster planning literature. The recommendations regarding fear messaging may have had harmful ramifications and impacts, especially for young people. CONCLUSION: We recommend that a wider multidisciplinary expertise is employed to deal effectively, ethically and holistically with future crises. Plans for future pandemics must include meaningful engagement with the public, particularly children and young people.

Misrepresenting Pragmatism: Response to Greenhalgh and Engebretsen.

The Covid-19 pandemic has engendered intense public debate about the nature and place of a "science-driven" approach to decision making in such contexts, with contributions by a range of scientific authors critical of actual policy decisions. In a recent article in this journal, Greenhalgh and Engebretsen (TGEE) propose that science-driven policymaking should be abandoned in favour of a "Pragmatist turn". We critically analyze their portrayal of Pragmatism and demonstrate that their characterization is historically inaccurate, particularly focusing on the neglect of its strong commitment to scientific method and related evidential requirements. We conclude that Pragmatism's caution and respect for standards of evidence are a valuable corrective to the pandemics of fear and action that bias responses to any pandemic infection.

Substandard and falsified medicines in African pharmaceutical markets: A case study from Ethiopia.

BACKGROUND: Substandard and falsified (SF) medicines are a global health problem. Their high prevalence is a threat to public health in low- and middle-income countries (LMICs). However, there are few street-level investigations of how this market works. This case study examines the supply and demand for SF medicines in Southern Ethiopia. METHODS: A cross sectional qualitative design, using semi-structured interviews supplemented by participant observation, was adopted. Study participants were selected using purposive, convenience, and snowball sampling techniques. They included pharmacists, physicians, wholesalers, pharmacy owners, regulatory staff, law enforcement agents and the local community. A total of 43 interviews were conducted. The study used Actor-Network Theory (ANT) as an analytic framework. RESULTS: The findings show that efforts to address the problem of SF medicines in Ethiopia struggle because of the lack of a clear framing of the issue and consensus on how it should be understood. The pharmaceutical market in Wolaita Zone, Southern Ethiopia is supplied with a wide variety of SF medicines from diverse sources. This complex supply chain emerges due to barriers to accessing essential medicines that are in demand. Control of SF medicines will require a range of interventions thoughtfully tailored to the local contexts and determinants of both supply and demand. CONCLUSION: The evidence of confusion, ambiguity, and uncertainty in defining the problem of SF medicines suggest that more research and policy work is required to refine understanding of the issue, and of the local market conditions that join demand and supply for different medicines in Southern Ethiopia. These are likely to apply more widely in comparable contexts throughout sub-Saharan Africa. The current global policy emphasis on stricter regulation and enforcement alone does not adequately address the social and economic factors that collectively create and shape user demand that is met by SF medicines.

Professions and the Social Order: Some Lessons from Burkina Faso?

The study of professions has been dominated by Anglo-American models, with their focus on a small group of legally licensed occupations. The field has recently shifted, mainly through studies of European experience, to a wider examination of the social management of expert workers. Very little has been written about developments in Africa and their implications for the way in which we might think about professions. This paper presents a case study of the role and practices of the medical profession in Burkina Faso, which has a relatively open market for the supply of healing services and limited regulation of the suppliers, whether physicians or traditional practitioners. The study returns to classic questions about the extent to which practice is shaped by the nature of occupational niches within the division of labor or to the development of a distinctive moral character among the workers within that niche.

L'étude des professions a été dominée par les modèles Anglo-Américains, avec leur emphase sur les petits groupes d'occupations légalement autorisées. Ce champ a changé récemment, surtout grâce à des études d'expériences européennes, se dirigeant vers un examen plus large de gestion sociale de travailleurs-experts. Peu a été écrit sur les développements en Afrique et leurs effets sur les manières dont nous réfléchissons à propos des professions. Cet article présente une étude de cas sur le rôle et les pratiques de la profession médicale au Burkina Faso, qui a un marché relativement ouvert pour l'offre de services médicaux et une réglementation limitée pour les prestataires, qu'ils soient médecins ou des 'practiciens' traditionnels. Cette étude revient aux questions classiques liées aux pratiques influencées par la nature des niches occupationnelles à l'intérieur de la division du travail ou le développement d'un caractère moral distinctif entre les travailleurs à l'intérieur de ces niches.

Why are doctors dissatisfied? The role of origin myths.

Leaders of the medical profession are increasingly concerned about the extent to which members have become discontented with their lot. Predictably, the profession tends to look outwards for explanations, to the changing social, economic and organizational contexts of health care. Sociologists, however, have long recognized that a 'social problem' is not an objective state of affairs but a complaint that the world falls short of the complainant's ideals. If we want to understand doctors' dissatisfaction, then, another approach might be to ask what would make them content. What are the ideals of medical practice? What are new doctors - and the wider public - led to expect that professional life will be like? How do these expectations relate to the contingencies and experiences of everyday medical work?

Healthcare workers' willingness to work during an influenza pandemic: a systematic review and meta-analysis.

To estimate the proportion of healthcare workers (HCWs) willing to work during an influenza pandemic and identify associated risk factors, we undertook a systematic review and meta-analysis compliant with PRISMA guidance. Databases and grey literature were searched to April 2013, and records were screened against protocol eligibility criteria. Data extraction and risk of bias assessments were undertaken using a piloted form. Random-effects meta-analyses estimated (i) pooled proportion of HCWs willing to work and (ii) pooled odds ratios of risk factors associated with willingness to work. Heterogeneity was quantified using the I(2) statistic, and publication bias was assessed using funnel plots and Egger's test. Data were synthesized narratively where meta-analyses were not possible. Forty-three studies met our inclusion criteria. Meta-analysis of the proportion of HCWs willing to work was abandoned due to excessive heterogeneity (I(2) = 99.2%). Narrative synthesis showed study estimates ranged from 23.1% to 95.8% willingness to work, depending on context. Meta-analyses of specific factors showed that male HCWs, physicians and nurses, full-time employment, perceived personal safety, awareness of pandemic risk and clinical knowledge of influenza pandemics, role-specific knowledge, pandemic response training, and confidence in personal skills were statistically significantly associated with increased willingness. Childcare obligations were significantly associated with decreased willingness. HCWs' willingness to work during an influenza pandemic was moderately high, albeit highly variable. Numerous risk factors showed a statistically significant association with willingness to work despite significant heterogeneity between studies. None of the included studies were based on appropriate theoretical constructs of population behaviour.

Introduction: why a Sociology of Pandemics?

Infectious disease has re-emerged as a public health threat in an increasingly globalised era, adding trans-national actors to traditional national and local government actors. This special issue showcases new sociological work in response to this challenge. The contributors have investigated the social construction of new and re-emerging diseases; the development of surveillance systems, public health governance; the impact of scientific/technical modalities on uncertainty and risk, the interplay of infectious disease, public health and national security concerns, and public and media responses. The case studies range broadly across North America, Europe and Asia and define new agendas for medical sociologists and public health policymakers.

The regulation of nicotine in the United Kingdom: how nicotine gum came to be a medicine, but not a drug.

This article explores the utility of actor-network theory (ANT) as a tool for socio-legal research. ANT is deployed in a study of the evolution of divided regulatory responsibility for tobacco and medicinal nicotine (MN) products in the United Kingdom, with a particular focus on how the latter came to be regulated as a medicine. We examine the regulatory decisions taken in the United Kingdom in respect of the first MN product: a nicotine-containing gum developed in Sweden, which became available in the United Kingdom in 1980 as a prescription-only medicine under the Medicines Act 1968. We propose that utilizing ANT to explore the development of nicotine gum and the regulatory decisions taken about it places these decisions into the wider context of ideas about tobacco control and addiction, and helps us to understand better how different material actors acted in different networks, leading to very different systems of regulation.

Let's dance: Organization studies, medical sociology and health policy.

This Special Issue of Social Science & Medicine investigates the potential for positive inter-disciplinary interaction, a 'generative dance', between organization studies (OS), and two of the journal's traditional disciplinary foundations: health policy and medical sociology. This is both necessary and timely because of the extent to which organizations have become a neglected topic within medical sociology and health policy analysis. We argue there is need for further and more sustained theoretical and conceptual synergy between OS, medical sociology and health policy, which provides, on the one-hand a cutting-edge and thought-provoking basis for the analysis of contemporary health reforms, and on the other hand, enables the development and elaboration of theory. We emphasize that sociologists and policy analysts in healthcare have been leading contributors to our understanding of organizations in modern society, that OS enhances our understanding of medical settings, and that organizations remain one of the most influential actors of our time. As a starting point to discussion, we outline the genealogy of OS and its application to healthcare settings. We then consider how medical sociology and health policy converge or diverge with the concerns of OS in the study of healthcare settings. Following this, we focus upon the material environment, specifically the position of business schools, which frames the generative dance between OS, medical sociology and health policy. This sets the context for introducing the thirteen articles that constitute the Special Issue of Social Science & Medicine.

On the remarkable persistence of asymmetry in doctor/patient interaction: a critical review.

Doctor/patient interaction has been the object of various reform efforts in Western countries since the 1960s. It has consistently been depicted as enacting relationships of dominance or oppression. Most younger medical practitioners have received interaction skills training during their professional education, intended to encourage more equal forms of consultation behaviour. However, the evidence that 'patient-centredness' has a positive impact on health outcomes is at best mixed. At the same time, empirical studies of consultations point to the remarkable persistence of asymmetry. These two factors together suggest that asymmetry may have roots that are inaccessible to training programmes in talking practices. Illustrating our argument with findings from conversation analytic studies of doctor/patient interaction, we suggest that asymmetry lies at the heart of the medical enterprise: it is founded in what doctors are there for. As such, we argue that both critical and consumerist analysts and reformers have crucially misunderstood the role and nature of medicine.

Narrative review of the UK Patient Safety Research Portfolio.

OBJECTIVES: The UK Patient Safety Research Portfolio (PSRP) commissioned 38 studies investigating the threats to patient safety in various clinical settings and evaluating safety-related service interventions. This paper reviews 27 of these studies, drawing out emergent and cross-cutting themes in terms of theory, research methods and thematic findings. METHODS: Given the diversity of PSRP studies, the paper takes a narrative approach that allows for qualitative description, interpretation and synthesis of the studies and their findings. RESULTS: The theoretical review shows the majority of PSRP studies draw upon a patient safety 'orthodoxy', developed from the concepts and models associated with the human factors approach. The methodological review shows that a diverse range of research designs and techniques have been utilized. Although many follow in the 'scientific' tradition, interpretative, mixed and innovative methods have been integral to research. The thematic review of findings highlights significant contributions to knowledge in the areas of 'people', 'organizations', and 'technology'. As well as identifying the various sources of risk in the organization and delivery of patient care, the studies also evaluate and make recommendations about service change and improvement. CONCLUSIONS: The PSRP has provided the foundations for significant theoretical, methodological and empirical advances in the area of patient safety. The findings and recommendations make important contributions to policy formulation and implementation as well as professional and managerial practice. Through this body of research the PSRP has supported the formation and growth of a thriving research community across academic, policy and professional communities.

The moral organization of the professions: Bioethics in the United States and France.

Bioethics is a relatively new endeavor, emerging as a discourse distinct from considerations of moral responsibility occurring within the professions of medicine and science. We use the 'de-centered comparative method' to examine how the emergence and development of bioethics varies across different social and cultural settings. In particular, we look at bioethical work in the United States and France, exploring these different manifestations of the movement toward external oversight of those working in medicine and the life sciences. The study of these varied processes of occupational development allows us to address two important issues. One is the way in which pathways of professionalisation are shaped by contingent cultural and historical factors. The other is the degree to which the increasing prominence of the bioethical occupation is the result of the professional desires of bioethicists and/or a concern for the public good.