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Trust, regulatory processes and NICE decision-making: Appraising cost-effectiveness models through appraising people and systems.

Brown, Patrick R, Hashem, Ferhana, Calnan, Michael (2015) Trust, regulatory processes and NICE decision-making: Appraising cost-effectiveness models through appraising people and systems. Social Studies of Science, 46 (1). pp. 87-111. ISSN 0306-3127. E-ISSN 1460-3659. (doi:10.1177/0306312715609699)

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http://dx.doi.org/10.1177/0306312715609699

Abstract

This article presents an ethnographic study of regulatory decision-making regarding the cost-effectiveness of expensive medicines at the National Institute for Health and Care Excellence (NICE) in England. We explored trust as one important mechanism by which problems of complexity and uncertainty were resolved. Existing studies note the salience of trust for regulatory decisions, by which the appraisal of people becomes a proxy for appraising technologies themselves. Although such (dis)trust in manufacturers was one important influence, we describe a more intricate web of (dis)trust relations also involving various expert advisors, fellow committee members and committee Chairs. Within these complex chains of relations, we found examples of both more blind-acquiescent and more critical-investigative forms of trust as well as, at times, pronounced distrust. Difficulties in overcoming uncertainty through other means obliged trust in some contexts, although not in others. (Dis)trust was constructed through inferences involving abstract systems alongside actors’ oral and written presentations-of-self. Systemic features and ‘forced options’ to trust indicate potential insidious processes of regulatory capture.

Item Type: Article
DOI/Identification number: 10.1177/0306312715609699
Uncontrolled keywords: health technology assessment NICE pharmaceuticals regulation trust uncertainty
Subjects: R Medicine > RA Public aspects of medicine
Divisions: Faculties > Social Sciences > School of Social Policy Sociology and Social Research > Centre for Health Services Studies
Depositing User: Michael Calnan
Date Deposited: 14 Sep 2015 08:39 UTC
Last Modified: 14 Feb 2020 04:07 UTC
Resource URI: https://kar.kent.ac.uk/id/eprint/50487 (The current URI for this page, for reference purposes)
Hashem, Ferhana: https://orcid.org/0000-0002-2544-1350
Calnan, Michael: https://orcid.org/0000-0002-7239-6898
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