Putting the NHS England on trial

Uncertainty-as-power, evidence and the controversy of PrEP in England

Dados Bibliográficos

ID12692575
AutoresMaurice Nagington (0000-0003-4914-0322, University of Manchester, autor correspondente), Tony Sandset (0000-0001-6813-9322, University of Oslo)
Ano2020
Volume46
Fascículo3
Páginas176-179
Data de publicação2020-02-13
Peer ReviewedSim
Open AccessNão
TipoARTICLE
PeriódicoMedical Humanities (JOURNAL)
Identificadores do periódicoISSN: 1468-215X • E-ISSN: 1473-4265
EditoraBMJ (PUBLISHER • GB)
DOI10.1136/medhum-2019-011780
PMID32054770
OpenAlexW3005629964
IdiomaEN
Citações recebidas9
Referências citadas10

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

Clinical trial · Family medicine · Health care · Human immunodeficiency virus (HIV · Men who have sex with men · Political science · Power (physics · Pre-exposure prophylaxis · Project commissioning · Public relations · Publishing · Rhetoric · Sociology · HIV, Drug Use, Sexual Risk · HIV/AIDS Research and Interventions · Law · Medicine · Sex work and related issues