Oonagh Corrigan

Rhetoric and Hype Where's the 'Ethics' in Pharmacogenomics?

There is increasing discussion in public and academic forums about the anticipated benefits of pharmacogenomics, as well as the attendant social and ethical implications of this research. Yet there is often an implicit assumption that the benefits of pharmacogenomics are ‘just around the corner’ and will significantly outweigh the costs. Furthermore, it is argued that the associated ethical issues are not as profound as those that emerge in other areas of genetics, and that experience gained wrestling with these other issues provides ample ethical and regulatory tools to deal with any problems arising with pharmacogenomics.We contend that this vision of ethical and social issues associated with pharmacogenomics is not so clear-cut. The scientific evidence is more complex and contested than the public, academics, and policy makers, have been led to believe, and while there may be real clinical benefits from this research, they are not likely to arrive in the near future. Pharmacogenomics research is also occurring in a terrain occupied by a multitude of different and powerful actors, with diverse and often competing interests. It is therefore essential to investigate the broader social and political context, unravel the various interests pressuring for early implementation, and deconstruct the hype in order to appreciate a fuller range of ethical and social consequences associated with the current developments of pharmacogenomics.

No one has yet properly articulated what we are trying to achieve: a discourse analysis of interviews with revalidation policy leaders in the United Kingdom.

Purpose To analyze prevailing definitions of revalidation (i.e., a recently instituted system of ongoing review for all physicians in the United Kingdom), the circumstances of their origin, and proposed applications, after a protracted and sometimes difficult decade in development. This was to support a more consensual approach to revalidation policy before its launch in 2012. Method In 2010 and 2011, the authors carried out a critical discourse analysis of interviews with 31 medical and legal revalidation policy makers. These individuals represented the main stakeholder bodies, including the General Medical Council, Academy of Medical Royal Colleges, British Medical Association, National Health Service Employers, and the departments of health from across the United Kingdom. Results The authors identified two overarching discourses: regulation and professionalism, held together by patients as “discursive glue.” Regulation frames revalidation as a way to identify “bad apples,” requiring a summative approach and minimum standards. Professionalism looks to revalidation as a process by which all doctors improve, requiring evolving standards and a developmental model. Conclusions These two discourses were not mutually exclusive; indeed, most interviewees used them interchangeably. However, they are in some regards at odds. Their coexistence has been supported by a shared discursive formation around patients. Yet the authors found little patient-centered policy in revalidation in its current form. The authors concluded that patients need to be recognized, making them present with an active voice. They also stressed the importance of established and ongoing evaluation of medical regulation as a policy and process.

The changing landscape of medical education in the UK

The UK shares many characteristics with other western developed countries, including a current adherence to the view that defining educational outcomes enables improvements in learning and teaching and a more effective management of the learning and assessment process. There are, however, some features that make UK medical education unique or that give it a distinctive flavour. This article looks at the various forces that shape medical education in the UK and the structures that underpin its delivery, and discusses the distinctive climate that is produced, in which doctors, students and medical teachers are expected to work. We examine and assess these special features of UK medical education and report on the ways in which medical education and medical educators are adapting to the complex and constantly changing environment. We conclude that the healthcare and higher education systems in the UK face unprecedented economic and political challenges over the coming years. Medical educators working within these systems have an important role in ensuring that these challenges are met and that standards are maintained and improved. A stronger professional architecture to support careers in medical education is needed to ensure that those involved in teaching medical students and doctors have the necessary training, time, resources and incentives to do it effectively.

Extraordinary normalcy: Home, relationships and identities in narratives of unpaid care

ABSTRACT Based on audio diaries and narrative interviews with family carers, this paper suggests care can be understood as an experience of ‘extraordinary normalcy’, meaning that profound shifts in home, relationships and identities take place whilst caring, yet these become part of the normalcy of family life. To maintain and understand a sense of normalcy, our participants utilise professional and technological interventions in the home and draw on notions of responsibility, reciprocity and role‐reversal as frameworks for explaining why they continue to care, despite the challenges it brings. The paper considers how domestic activities performed in the home can both highlight the extraordinary aspects of care and help maintain the normalcy of the everyday. Extraordinary normalcy is a concept that problematises definitions of care that remove it from the relational and everyday, yet acknowledges the challenges people face when performing care. This paper contributes to a call for a narrative based development of social policy and makes recommendations for policy and practice based on the in‐depth accounts of family carers. HIGHLIGHTSCaring precipitates profound shifts in home, relationships and identities that are incorporated into the everyday.Caring for a family member with additional needs can result in a changing experience of home, relationships and identities.Successful professional or technological interventions in the home are those that facilitate routine and familiarity.Changes or interruption to domestic routines can highlight the challenges of caring and the progression of illness.Notions of responsibility, reciprocity and role‐reversal provide explanatory frameworks for caring for a family member.

The transition from medical student to junior doctor: today's experiences of Tomorrow's Doctors

Medical Education 2010: 44: 449–458

The transition from medical student to junior doctor

Medical Education 2010: 44: 449–458