Putting the NHS England on trial: uncertainty-as-power, evidence and the controversy of PrEP in England

被引:11
|
作者
Nagington, Maurice [1 ]
Sandset, Tony [2 ]
机构
[1] Univ Manchester, Fac Med Biol & Hlth, Sch Hlth Sci, Manchester, Lancs, England
[2] Univ Oslo, Inst Interdisciplinary Hlth Sci, Fac Med, Oslo, Norway
关键词
HIV; AIDS; sexual medicine; public health; health policy; medical ethics; bioethics;
D O I
10.1136/medhum-2019-011780
中图分类号
C [社会科学总论];
学科分类号
03 ; 0303 ;
摘要
Pre-exposure prophylaxis (PrEP) (Truvada) is a medication which if taken correctly is almost entirely effective in preventing HIV infection. In regions and countries where it has been widely taken up, HIV seroconversion rates have significantly decreased. Alongside testing and treatment, it offers the very real prospect of ending HIV infections. However, in England, commissioning it has (and still is) a controversial process, where NHS England has repeatedly raised supposed 'uncertainties', first legal and then scientific. The same has not happened in Scotland, where PrEP was commissioned to anyone who needed it in April 2017. This article presents a close reading of the IMPACT trial protocol, which we conclude cannot answer the questions it sets out to answer. We then suggest that the uncertainties the trial claims to address are in fact a tool of power which is deployed to strategically ration healthcare; introduce uncertainty about commissioning PrEP; and shift the boundary between individual responsibilities and state responsibilities for public health and HIV prevention. We conclude that all the above constitute an unethical use of clinical trial rhetoric, systematically discriminate against minority and vulnerable groups, and ration healthcare for those who most need it. As such, we call on all academics, clinicians and activists to resist further unethical misuses of clinical trial rhetoric.
引用
收藏
页码:176 / 179
页数:4
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