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Gendering HPV in the UK: A socio-political analysis of inclusion and exclusion in sexual health technology appraisal 30 Jun 2018

In April of this year, Public Health England expanded their national HPV vaccination agenda to include men who have sex with men (MSM) to reduce the risk of associated cancers and protect a previously overlooked group. However, the conditional and "opportunistic" manner in which the vaccine is made available to MSM differs substantially from the way girls in the UK are vaccinated which poses considerable equity issues. While evaluations of this program have found it clinically and economically feasible, they fail to mention social implications or gender barriers to the vaccine. My proposed research draws upon social discourse analyses of key policy publications to produce a socio-political evaluation of this new program. Key research goals: 1. Review the processes through which vaccine appraisal and sexual health technology assessment are carried out in the UK. 2. Determine the extent to which social factors, such as sexual identity and stigma, are addressed by current appraisal models. 3. Set out an approach to modeling social factors and identity inclusion in vaccine appraisal systems. 4. Suggest measures to promote public discourse on social equity within vaccine appraisal.

MSc in Health and International Development 11 Jul 2018

The MSc Health and International Development draws on LSE’s strengths in the social sciences and equips students with the skills to analyse health issues using a range of approaches, qualitative and quantitative. Graduates will be critical and analytically sophisticated, and able to grapple with complex health-related questions. Grounded in multi-disciplinary social science approaches to health, the programme’s core courses expose students to theoretical, substantive and methodological debates in health-related research. The compulsory research design course supports students to develop as independent researchers so that they can develop a dissertation tackling a health-related issue on a topic that motivates them. Optional health-related courses from a range of disciplinary perspectives (political science, anthropology, development studies, social psychology) allow students to tailor their learning to their career aspirations. In this respect it is a unique degree, as it embeds analysis of health in a multidisciplinary degree of international development. The integration of health and development make the degree truly distinctive, and different from health degrees taught in schools or departments of health. Studentships will be allocated on merit; not just outstanding academic achievements, but a highly motivated personal statement and experience (research, professional, voluntary). Key words: health; multidisciplinary; international development; social sciences

Exploring physician altruism to improve quality of care 27 Jun 2018

Physicians’ concern for patient well-being (altruism) is commonly considered an important driver of quality in healthcare. Despite this theoretical recognition, interventions to improve care quality are often guided by the notion that physicians must receive extrinsic incentives (rewards, sanctions, etc.) to do the right thing. A reason is that empirical evidence on the influence of altruism in real-world clinical settings is scarce, given a number of methodological challenges. We argue for a new research agenda to explore physician altruism in applied research and encourage its recognition in care quality regulatory practice. First, we propose an innovative approach for identifying altruism in real-world settings, which addresses existing methodological challenges: we employ ‘mystery’ standardised patients to test whether patients’ financial well-being, as signalled by their insurance status, plays a role in physicians’ care quality and prescribing behaviour. Second, we study the extent to which altruism mediates care quality responses to private performance feedback (a regulatory intervention that specifically excludes extrinsic incentives, by design). The novelty of our study design and expected outputs will be disseminated to relevant academics and policymakers, to inform future research and policy practice.

Zika and the Regulation of Health Emergencies: Medical Abortion in Brazil, Colombia and El Salvador 30 Nov 2017

Health emergencies expose faultlines in health sytems. One such faultline is the regulation of medical abortion (the use of mifepristone and misoprostol to terminate pregnancy) during the Zika outbreak and the impact this has on women's reproductive health at a time of uncertainty. This proposal seeks to analyse the intersection of Zika, regulation and medical abortion through a comparative case study of Brazil, Colombia and El Salvador. Each of these states had Zika infected women (albeit with differing incidence) yet represent diverse regulatory environments for medical abortion, ranging from legalisation in Colombia to criminalisation in El Salvador to medical abortion drugs being on the list of prohibited smuggled drugs in Brazil. In spite of regulation, however, women have still been accessing medical abortion during the Zika epidemic, assumed through civil society groups, pharmacies and the black maket. This research analyses the impact of the Zika outbreak on how women access medical abortion, and how national regulation has impacted women's choices and abortion service provider's activity during this emergency. Accordingly, it will assess the intersection of these three tenets in the case study locations, and in doing so, produce a conceptual framework for understanding the regulation of abortion during health emergencies.

Human rights human remains: forensic humanitarianism and the politics of the grave 01 Feb 2017

This project advances a pioneering analysis of the ‘forensic turn’ in humanitarianism. This denotes the effort to establish forensically the identities and causes of death of the mass victims of atrocities such as enforced disappearance, torture, genocide and war crimes. It has flourished in diverse settings such as Argentina, Guatemala, Mexico, Rwanda, South Africa, Bosnia-Herzegovina, Spain and Libya. In such contexts exhumations and forensic identification carry enormous social force. They represent a powerful way of establishing ‘the truth’ about what happened. Yet forensic identification is a social act. It interacts with legal, political and humanitarian imperatives which include facilitating accountability, combatting political and cultural denial, and returning the dead to families to assist psychological ‘closure’. The project examines the emergence, social complications and implications of forensic investigations of atrocity. It provides the first (global) history of the forensic turn in humanitarianism, investigates challenges to, and innovations in, the forensics field via an original analysis of the case of Mexico, and explores the hypothesis that as a result of the forensic turn we can now argue that the dead have human rights. In so doing, the project aims to change the way we think about forensic action and about human rights.

Who Funds the Funder? An Investigation into Taxation to Finance the Development of New Antibiotics. 30 Jul 2017

The traditional antibiotic funding model involves pharmaceutical companies funding drug development; in return, they receive a period of patent protection, which allows them supernormal profits as the monopoly supplier. However, growing antimicrobial resistance means that antibiotic use needs to be limited. Limiting sales would reduce the financial incentive for the development of new antibiotics, at a time when growing resistance causes a critical need for further development. Proposed replacement funding models seek to delink profits from sales volumes; as such, it will be necessary to replace market incentives for innovation with other financial incentives. Though proposed models include new financial incentives, where this money will come from remains an open question. The pharmaceutical industry will receive these financial incentives, and so it seems appropriate that they should be taxed to help finance them. In my research, my key goals are to: Review potential financing of antibiotics development from taxation of the pharmaceutical industry. Investigate how financing arrangements can balance antibiotics stewardship, equitable access to antibiotics and incentives for antibiotics innovations. Set out how taxes could be enforced despite the international nature of this industry. Set out a pragmatic road map for financing antibiotics development moving forward.

Gender, Structures and Social Wellbeing: A Socio-Legal Exploration of Conflict-Related Gender-Based Violence in Bosnia Herzegovina and Liberia 10 Mar 2016

The main aim of the research is to investigate the cultural and social contexts of health or social wellbeing for survivors of conflict-related gender-based violence (CRGBV) in Bosnia and Herzegovina (BiH) and Liberia. In particular, the study examines the influence of gender norms and structural forms of inequality on women’s engagement with civil society organisations and legal institutions focused on psycho-social and legal support for women victims in order to identify experiences and barriers to social wellbeing. The study engages key civil society organisations and legal institutions through qualitative fieldwork methods and data collection. The key goals of the project are to: Conduct qualitative fieldwork to generate qualitative data from civil society and legal institutions providing support for victims of CRGBV on experiences and barriers analyse this data in combination with gender and socio-legal theories about CRGBV in a peer-reviewed journal article identifying new and original areas to be further researched and investigated, based on exploratory research findings Engage with experts at a workshop on CRGBV in order to refine a larger grant application, engage with interdisciplinary scholarship and develop a policy-relevant research agenda Design a larger collaborative, and comparative, research grant proposal for Wellcome

The capabilities approach as ethical foundation for a cognition policy based on a metric of 'cognitive footprint' 10 Mar 2016

Cognition (the set of all mental abilities) is quintessential to human functioning and it is one of society’s most valuable assets. However, unlike physical health, disability, economic growth or happiness it has never become a focal point of public policy. Nonetheless, cognitive functioning is dynamic; changes throughout the life course and a wide range of variables affect it, positively or negatively. In a recent discussion piece in The Lancet (by two of the applicants of this proposal) a case was made for a cognition policy and a metric for policy evaluation, coined ‘cognitive footprint’. In this project we want to investigate the ethical basis of such a cognition metric for policy evaluation purposes. A promising starting point is Sen’s ‘capabilities approach’ to the goals and limitations of public policy, which defines real wellbeing in terms of human development and flourishing rather than in terms of wealth or happiness. This framework has become influential in many domains of health and social care and seems to offer the right basis to explore the contours of an ethical cognition policy.

Primary healthcare accountability in Karnataka. 02 Feb 2015

The National Rural Health Mission in India introduced Village Health and Sanitation Committees (VHSCs) in 2007 to improve accountability of primary healthcare to the local community. However, beyond documenting the frequency of meetings, little is known about their impact in terms of health promotion. Building on research conducted by the Principle Investigator and Collaborator over the past three years, this research aims to develop a framework to study the extent to which these committees ar e providing leverage to improve rural health systems. The research will take place in the 12 villages served by Gumballi primary health centre in Karnataka managed by the Karuna Trust NGO with whom the researchers have established linkages. Our research approach will be to triangulate qualitative data on relevant VHSC processes we have identified (such as building awareness on health issues, local prioritisation of untied funds, planning and monitoring) with quantitative trend data on health i ndicators. In line with VHSC activity, our focus will be on water-borne diseases and maternal health. The relevance of this project will be in terms of providing a framework for integrating the community through VHSCs with the formal health systems apparatus.

Care as Science: The Role of Animal Husbandry in Translational Medicine. 27 Jan 2014

It is becoming increasingly common to hear life scientists say that quality scientific findings rely upon quality animal care. This research project asks why and how animal care is being made an explicit part of scientific knowledge production in the context of translational medicine today. This project is important because scientific concern with animal husbandry denotes an historical shift. Animal care work has historically been marginalized in science, as evidenced by its systematic erasure f rom scientific journal articles, its conceptualization as an extra-scientific concern that animal technicians and veterinarians are responsible for as opposed to scientists themselves and the idea that care is opposed to objectivity. This research asks to what extent UK scientists understand animal husbandry and care as a crucial part of scientific research, and the factors that explain this. It also asks how specific scientists are incorporating improved animal care and husbandry into their pre clinical research, and how these practices are informed by the fields of in vivo animal research and translational medicine. In sum, it seeks to understand how the ethical debates surrounding animal experimentation are being transformed into a scientific priority in the contemporary moment, and what this means for both in vivo science and translational medicine. In the process, it collaborates with a series of academic and non-academic stakeholders in order to pursue the joint goals of improving animal welfare in science and translating scientific findings into clinical practice. The project is thus important from both a sociological and broader societal perspective.

LSE Space for Thought Literary Festival 2014 - 'Knowing How: tacit knowledge in medicine, business and the arts . 17 Dec 2013

For the last 5 years, the London School of Economics and Political Science has been hosting an annual Literary Festival designed to explore the links between the arts, sciences and social sciences, and encourage these traditionally separate disciplines to reach out to one another. All events in the Festival are free of charge, and open to all. This Festival forms part of the LSEs prestigious public lecture programme. The Festival brings thousands of people to LSE each year, including students, academics and members of the general public. For the opening event of the 2014 Festival, we are hosting a panel discussion Knowing How: tacit knowledge in medicine, business and the arts with Fiona Bevan (singer/songwriter), Professor Harry Collins (Cardiff University), Professor Roger Kneebone (Engagement Fellow, Wellcome Trust) and Fiona Sampson (Professor of Poetry, Roehampton), chaired by Richard Bronk (Visiting Fellow, LSE). This will be followed by a poetry reading from Fiona Sampson, ending with a drinks reception open to all the audience to attend. We believe this is an excellent way to engage a diverse audience in an interesting, but little explored, area of both the sciences and the arts, and explore the connections between them.

Trading Medicines. The Global Drug Trade in Perspective. 16 Sep 2013

This workshop explores the global trade in medicinal drugs between the sixteenth and eighteenth centuries. Access to medicines was one of the motivations for European expansion, but little is known about the size or structure of the early modern global market in drugs that emerged as international exchange systems expanded and deepened in this period. Most detailed work on trade has focused on bulk commodities instead. By bringing together researchers working on the drug trade in the Spanish Emp ire, the Portuguese Empire, the Netherlands and Russia, the workshop will seek to develop a new understanding of the organisation, scale and composition of the drug trade that is properly comparative in nature, and that explores crucial linkages between the Americas, Asia and Europe. Our aim is to revise and expand historical understanding of the drug trade in order to build a broad picture of developments across the early modern period, and the consequences they had for producers, traders and c onsumers. By focusing on the scale, structure and development of medical trade flows, the workshop will complement recent studies that have shed light on the negotiation, interpretation and reception of new medicines.

Europe's Medical Revolutions. Measuring Medical Demand in Early Modern Europe. 19 Nov 2012

This workshop explores the development of markets for medicine in early modern Europe, focusing on one of the most fundamental questions in the history of medicine: when and why did most people start to look beyond their family and neighbours for medical care? It will bring together researchers using a range of different sources to analyse developments in the consumption of medical services in early modern France, the Netherlands and Venice, and in eighteenth-century England. Papers will present new evidence of continuity or change in demand for healthcare and in the types of provision the sick employed in different periods, with a focus on estimating changes in the level and characteristics of medical consumption over the long-run in different parts of Europe. Each paper will also discuss the potential of the sources they used to offer a guide to long-term changes in medical consumption. The workshop will centre on evaluating our ability to measure the levels and characteristics of a key aspect of health care in order to help historians of medicine understand the long-term development of the provision and consumption of health care across Europe.

The VOICES Study: Dissemination Activities. 17 Oct 2011

Purpose: To disseminate the findings of the Wellcome Trust funded research project, VOICES (Voices on Identity, Childhood, Ethics and Stimulants: Children join the debate). The grant requests funds to cover three dissemination activities: 1. creation of a videoarchive of slides which feature close-captioned data excerpts and childrens drawings of their brains; 2. creation of two final reports using mixed media formats, one summarizing the UK findings, the other summarizing the US findings; 3. upgrading, optimizing and maintaining the VOICES website ( as an accessible and educational web-based source of information about the VOICES study.

Final deposit of 28 interviews from Wellcome funded project history of mammalian developmental biology in the UK 20 May 2011

We have conducted, transcribed, edited and annotated most of 29 interviews with key figures in the field of mammalian developmental biology in the postwar period in the UK as part of a previous Wellcome funded project (RG50521) and we are seeking to deposit these, along with supporting archival material (where available) and original copies of the digital audio files (where permitted), in the British Library,. to contribute to their oral history project, and to augment their collection on the history of the life sciences. In order to complete this task we face a final hurdle, which is the completion of the extensive copyright permission paperwork required for deposit in BL. We are therefore seeking funds to employ a summer assistant to aid with this final stage in our project. We will also ask the assistant to do a final edit of all transcripts and a minimal amount of metadata for them for future reference. They will also assist with the necessary formatting of the transcripts to the BL requirements. We estimate approximately 10 hours per interview will be needed, and are thus seeking funds for 300 hours of work.

The Consumption of Medical Services in Paris, c. 1650-c. 1750. 26 Nov 2009

My project is an in-depth study of the consumption of medical services in Paris between c. 1650 and c.1750. I want to understand the frequency and manner in which people utilized the services of paid healers over the whole life cycle, from childhood to old age. I thus expand the scope of consumption studies, which have specialised in culture and luxury, to include medical services. I take Paris as a test case. Major transformations occurred in Paris under the Bourbons, turning it into the medica l centre of modern Europe. Part of my research will utilize records of medical debts over a century by sampling notarial archives which record medical fees in post-mortem inventories and guardianship accounts. In addition, I will systematically examine civil jurisdiction records in order to uncover expenditure on orphans' health and legal cases for the recovery of medical debts. I will also study how households and convents paid for medical services and commodities. My study will give a unique i nsight into the nature of medical services, the monetary relationships between patients at different stages in the life cycle and practitioners, the rhythm and scale of medical payments, and the general organisation of medical services and commodities.

Issues in end of life care: a UK-US comparative perspective 13 Jul 2010

Issues pertaining to end of life care are among the most topical and important in the health policy discourse in the UK and the US, highlighted, for example, by recent controversial recommendations by the National Institute for Health and Clinical Excellence over the provision of high cost cancer interventions, and Sarah Palin's warning against the creation of 'death panels'. The issues can encompass, for instance, ethical (when is it ever right to 'pull the plug'), economic (how much is the end of life 'worth'), and political (is an open, public debate on the end of life even possible?) concerns, all of which are perhaps substantively influenced by the institutional construct of health care systems, which differ none more so than between the UK and the US. The objective of this seminar is to enlighten the 'end of life' debate ongoing in both the UK and the US, and to explore whether the differential understanding across these countries is intractable, or whether there is genuine scope for cross-country learning and understanding. The intention would be to publish the proceedings as a journal special issue.

From communication to deliberation: the impacts of new forms of public engagement on biomedical scientists - extension 13 Jul 2010

The goal of the proposed research is to provide rigorous policy advice concerning the opportunities and barriers that are encountered by biomedical scientists with respect to the development and establishment of methods of public engagement with biomedical science. To achieve this, the research objective is to collect data on the understandings, experiences and responses to notions of public engagement by interviewing scientists working in the biomedical sciences. The primary project outcome is a comprehensive, empirically-based analysis of understandings of 'the public' and 'public engagement' from within biomedical science. These research goals will be achieved through three research methodologies: 1. A literature review of the relevant academic, policy and practitioner literature; 2. Semi-structured interviews with scientists working in selected areas of the biomedical sciences; and 3. The collation of relevant public statements (in the media and at public events) by biomedical scientists. Project outcomes will be enhanced through dissemination of the research results to end-user and academic groups (primarily via an interim report and end-user workshop, a final report, a prestigious launch seminar, other end-user speaker opportunities, and academic journal articles and conferences).

Costing mental health care in Uganda. 20 Nov 2008

The goal of the research is to generate evidence on mental health financing in Wakiso District. Specific objectives are: 1. to gather information on policies for mental health care services in Uganda; 2. to study costing of mental health services both at the allopathic as well as at traditional healer sites; 3. to disseminate the results in Uganda and more widely. The study will take place at Entebbe Grade B Hospital and Gombe Hospital Mental Health Clinics and at two Traditional Healer's premises in the Wakiso area. The study population will be adults with mental disorders. The dependent variable will be costs of care for the current mental illness episode; independent variables will include socioeconomic status, knowledge and practices in relation to mental disorders and mental health services. The study will use a cross-sectional design and will have qualitative and quantitative components. Quantitative data analysis will include population characteristics, bivariate and multivariate analysis, and qualitative data analysis will use the grounded theory approach. Findings will be disseminated widely in Uganda and the region, through attendance at workshops and conferences and writing articles for peer reviewed journals

BIONET - Ethical Governance of Biomedical Research - China - EU. 18 Feb 2009

Biological and biomedical research have become global undertakings involving cross-national collaborations. In such a context it is essential that appropriate mechanisms of ethical and scientific oversight of research projects are developed to accommodate situations where scientists operate accross a multiplicty of regulatory and cultural contexts. BIONET is an FP6 core-funded project which has worked collaboratively for 3 years with 20 European and Chinese partners, and in collaboration with the MRC, mapping out ethical governance practices in thefields of regenerative medicine, clinical trials and biobanking in China and Europe, undertaking empirical research, case studies, workshop collaborations, exchange visits and other