Trust, regulatory processes and NICE decision-making: Appraising cost-effectiveness models through appraising people and systems
Trust, regulatory processes and NICE decision-making: Appraising cost-effectiveness models through appraising people and systems
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DOI：
10.1177/0306312715609699
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发表时间：
2016-02-01
影响因子：
3
通讯作者：
Calnan, Michael
中科院分区：
文献类型：
--
作者：
Brown, Patrick;Hashem, Ferhana;Calnan, Michael
本文介绍了英国国家健康与护理卓越研究所（NICE）对昂贵药物成本效益监管决策的民族志研究。我们探讨了信任作为解决复杂性和不确定性问题的一种重要机制。现有的研究指出，信任对监管决策的重要性，通过这种决策，对人的评价成为评价技术本身的代理。虽然这种（不）信任制造商是一个重要的影响，我们描述了一个更复杂的网络（不）信任关系，也涉及到各种专家顾问，委员会成员和委员会主席。在这些复杂的关系链中，我们发现了更多的盲目默许和更多的批判调查形式的信任，以及有时明显的不信任。在某些情况下，通过其他手段克服不确定性的困难迫使人们信任，尽管在其他情况下并非如此。(Dis)信任是通过涉及抽象系统的推理以及演员的口头和书面自我陈述来构建的。系统性特征和“被迫选择”的信任表明潜在的阴险过程的监管捕获。
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.