The dark side of hope and trust: Constructed expectations and the value-for-money regulation of new medicines

摘要: New medicines represent exciting possibilities to individual patients for improved futures through reduced morbidity, as well the potential disappointment where promised outcomes are not forthcoming. For healthcare systems these technologies can enable enhanced effectiveness spiralling costs, depending on value-for-money offered. Amidst uncertainty over efficacy and pricing, institutions such National Institute Health Clinical Excellence have been set up regulate cost-effectiveness of new products. The increased transparency this regulation, combined with inescapable uncertainties, leads heightened politicisation decision-making an insidious subjectivity beneath a veneer rational-bureaucracy. This paper develops theoretical framework understanding influence hope within contexts. Conceptualised here ideological, affective prone lapsing into trust, is considered shape lifeworld-background regulatory decisions mask around effectiveness. These processes challenge regulator legitimacy polycentric regimes, distortion communication manipulation blame.