Light me up: power and expertise in risk communication and policy-making in the e-cigarette health debates

Abstract

This paper presents a detailed account of policy-making in a contemporary risk communication arena, where strong power dynamics are at play that have hitherto lacked theoretical analysis and empirical validation. Specifically, it expands on the understanding of how public health policy decisions are made when there is a weak evidential base and where multiple interpretations, power dynamics and values are brought to bear on issues of risk and uncertainty. The aim of the paper is to understand the role that power and expertise play in shaping public health risk communication within policy-related debates. By drawing on insight from a range of literatures, the paper argues that there several interacting factors that shape how a particular narrative gains prominence within a wider set of perspectives and how the arguments and findings associated with that perspective become amplified within the context of policy choices. These findings are conceptualised into a new model – a policy evaluation risk communication (PERC) framework – and are then tested using the Electronic cigarette debate as a case study.     

Cost-effectiveness of delayed-release dimethyl fumarate for the treatment of relapsing forms of multiple sclerosis in the United States

Objective:

To assess the cost-effectiveness of delayed-release dimethyl fumarate (DMF, also known as gastro-resistant DMF), an effective therapy for relapsing forms of multiple sclerosis (MS), compared with glatiramer acetate and fingolimod, commonly used treatments in the US.

Methods:

A Markov model was developed comparing delayed-release DMF to glatiramer acetate and fingolimod using a US payer perspective and 20-year time horizon. A cohort of patients, mean age 38 years, with relapsing-remitting MS and Kurtzke Expanded Disability Status Scale (EDSS) scores between 0–6 entered the model. Efficacy and safety were estimated by mixed-treatment comparison of data from the DEFINE and CONFIRM trials and clinical trials of other disease-modifying therapies. Data from published studies were used to derive resource use, cost, and utility inputs. Key outcomes included costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. Alternative scenarios tested in a sensitivity analysis included drug efficacy, EDSS-related or relapse-related costs, alternative perspectives, drug acquisition costs, and utility.

Results:

Base-case results with a 20-year time horizon indicated that delayed-release DMF increased QALYs +0.450 or +0.359 compared with glatiramer acetate or fingolimod, respectively. Reductions in 20-year costs with delayed-release DMF were ?$70,644 compared with once-daily glatiramer acetate and ?$32,958 compared with fingolimod. In an analysis comparing delayed-release DMF to three-times-weekly glatiramer acetate and assuming similar efficacy and safety to the once-daily formulation, 20-year costs with delayed-release DMF were increased by $15,806 and cost per QALY gained was $35,142. The differences in costs were most sensitive to acquisition cost and inclusion of informal care costs and productivity losses. The differences in QALYs were most sensitive to the impact of delayed-release DMF on disease progression and the EDSS utility weights.

Conclusion:

Delayed-release DMF is likely to increase QALYs for patients with relapsing forms of MS and be cost-effective compared with fingolimod and glatiramer acetate.     

The Role of Personal Values in Fair Trade Consumption

Research in the U.S. on fair trade consumption is sparse. Therefore, little is known as to what motivates U.S. consumers to buy fair trade products. This study sought to determine which values are salient to American fair trade consumption. The data were gathered via a Web-based version of the Schwartz Value Survey (SVS) and were gleaned from actual consumers who purchase fair trade products from a range of Internet-based fair trade retailers. This study established that indeed there are significant interactions between personal values and fair trade consumption and that demographics proved to be useless in creating a profile of the American fair trade consumer.     

The state of total quality management: a review

As quality is seen as becoming a competitive mandate, many organizations are said to be embracing the practice of total quality management (TQM) as an improvement strategy. In this paper, we will be examining the extent to which quality management (QM) - TQM in particular-has been adopted by organizations. Just as there are companies that claim that QM is benefiting them, the concept is also increasingly being criticized for not bringing about the promised results, and in the following review, studies that have highlighted this disparity in opinions will be reviewed. Increasingly, doubts have been raised as to whether partial quality management - and not TQM - is being practised in organizations. This paper will also examine the difficulties companies may be faced with in their attempts to embrace TQM.     

Determining female consumers’ perceptions of garment fit,personal values and emotions when considering garment sizing

Female consumer's clothing shopping experience is primarily influenced by the appearance and fit of a garment that may be influenced by their personal values and is a process that involves emotions (Otieno et al., 2005; Lopatovska and Arapakis, 2011). Very little research focussing on the emotional impact and the role that personal values play in the female consumers’ shopping experience of ready‐to‐wear garment fit has been conducted in South Africa to date. The primary objective of this study was to explore the areas of concern of garment sizing to establish the emotional impact garment sizing and the resulting fit have on the female consumer purchasing behaviour when evaluated against their personal value system. This study applied the means‐end chain theory approach that allowed the researcher to explore female consumers’ personal values and the resulting emotions, through the application of the laddering interview techniques. Using open‐ended questions, this study aimed to discover the role of female consumers’ perceptions of garment sizing and the resulting emotional effects of garment fit on their purchasing decisions. The findings from the data collected from a purposeful and convenient sample of 62 female consumers from Gauteng, Johannesburg showed that the majority of the participants in this study failed to attain their personal values through the fit of a garment due to inconsistent, unreliable and inaccurate sizing, garment sizing which is unsuitable for various body shapes and the unavailability of certain clothing sizes in ready‐to‐wear garments. The study established that it is extremely important that South African clothing manufacturers and designers should strategize to satisfy the clothing need of the consumers who are currently having problems with garment sizing, by understanding female consumers’ garment sizing and fit needs through extended research of their target markets.