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Background: Available data suggest that general practitioners (GPs) in Germany use complementary and alternative medicine (CAM) modalities more frequently than GPs in many other countries. We investigated the country differences perceived by general practitioners who have worked in Germany and in one of four other European countries with regard to the role of complementary and alternative treatments in primary care. Methods: In this qualitative study we conducted semi-structured interviews with 12 GPs who had worked both in Germany and Italy, the Netherlands, Norway or the United Kingdom (UK; n = 3 for each of the four countries). Participants were asked how they perceived and experienced country differences regarding health system, relevance of CAM modalities, the role of evidence-based medicine (EBM) and science, and how they handle so-called indeterminate situations. For the analysis, we followed a thematic analysis approach according to Braun and Clarke with focus on themes that cover CAM. Results: Participants unanimously reported that they perceived CAM to be more relevant in general practice in Germany compared to the other countries. We identified four overarching themes in relation to the perceived reasons for these differences. Firstly, physicians with experiences in countries with a strong EBM and science orientation (Netherlands, Norway and the UK) considered the deeply ingrained view in national healthcare systems and GP communities that CAM modalities are not evidence-based as the main reason for the lower use of CAM by GPs. Secondly, extensive training of communication skills was cited as a reason that reduced the need for CAM in the Netherlands, Norway and the UK. Thirdly, differences in patient expectations and demands were perceived as a factor contributing to greater utilisation of CAM by German GPs compared to the other countries. Finally, country-specific reimbursement mechanisms were considered as a factor influencing the role of CAM in general practice. Conclusions: The study results point to major differences between countries with regard to the role of CAM in GP care. Differences in basic attitudes in the discipline of general practice, patient expectations and system conditions appear to play an important role here. [ABSTRACT FROM AUTHOR]

Health innovation is mainly envisioned in direct connection to medical research institutions or pharmaceutical and technology companies. Yet, these types of innovation often do not meet the needs and expectations of individuals affected by health conditions. With the emergence of digital health technologies and social media, we can observe a shift, which involves people living with illness modifying and improving medical and health devices outside of the formal research and development sector, figuring both as users and innovators. This patient‐led innovation has been celebrated in innovation studies and economics as a "bottom‐up" type of innovation. In this article, we take a closer look at open‐source patient‐led innovation in the context of type 1 diabetes care. In our inquiry, we pay particular attention to the social and ethical dimensions of this innovation, building on empirical material. Upon exploring the notion of patient‐led innovation and its socio‐political context through the lens of intersectional and global health justice, we argue that a proactive strategy is needed to ensure that open‐source patient‐led innovation will be more globally accessible, center the health needs of the most underserved populations, as well as facilitate equitable and just health benefits. To support this aim, we provide a range of examples of different initiatives addressing the persistent inequalities that have so far inhibited patient‐led innovation from more fully materializing its innovative potential. [ABSTRACT FROM AUTHOR]

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We propose a step‐by‐step methodological framework of translational bioethics that aims at changing medical practice according to normative–ethical requirements, which we will thus call "transformative medical ethics." The framework becomes especially important when there is a gap between widely acknowledged, ethically justified normative claims and their realization in the practice of biomedicine and technology (ought–is gap). Building on prior work on translational bioethics, the framework maps a process with six different phases and 12 distinct translational steps. The steps involve various research activities including conceptual philosophical inquiry and (socio‐)empirical research. On the one hand, the framework can be used as a heuristic tool to identify barriers to the transformation process. On the other hand, it can provide guidance for researchers and practitioners to develop appropriate (conceptual action and practice) models, which are then implemented and evaluated in specific practice contexts. We use the example of realizing the norm of respect for autonomy in the practice of medical decision‐making to illustrate the framework. Further research is required, for example, to theoretically underpin the framework, to apply it to other ought–is gaps, and to evaluate its feasibility and effectiveness in various practice areas. Overall, the framework of transformative medical ethics suggests a strategic process to investigate and promote practice change that is ethically informed in all phases. [ABSTRACT FROM AUTHOR]

In this article, I reflect on my empirical engagement in the global (digital) health movement #WeAreNotWaiting in the context of Type 1 Diabetes. I want to take my relationships and interactions in this community as a starting point to discuss the multifacetedness of doing ethnographic research in health-political activist communities while not being affected by the health conditions the research participants are affected by and not sharing their explicit personal-political aim. Building on Donna Haraway's conceptualization of situated knowledge and Kim TallBear's notion of ethics of accountability, I empirically retrace three accounts of disclosing otherness in my empirical engagement that were generative for my understanding of the movement. I suggest that the moments where one needs to explain oneself, where one is met with skepticism, or experiences tensions, might be uncomfortable and challenging but can be generative. To engage with them can contribute to the accountability of the ethnographer. [ABSTRACT FROM AUTHOR]

In this article, I explore knowledge practices in increasingly digitized, data-driven, and personalized healthcare settings by empirically focusing on the "looper community" in type 1 diabetes. This community develops and uses open-source automated insulin delivery systems and frequently criticizes slow innovation cycles and data monopolies of commercial device manufacturers. Departing from the literature on patient knowledge, I argue that studying these knowledge practices at the intersection of digitized and personalized health care, open-source innovation, and patient activism calls for an expansion of the theoretical notions of patient knowledge. Empirically I map out three knowledge practices: technical, including maintenance and repair work; recursive, including the building and maintenance of adjunct care and support structures; and methodological, including scientistic forms of self-experimentation. I propose "elaborative tinkering" to foreground the nuances of when and how patients' different forms of knowledge practices intertwine and when they are kept apart. This approach offers new concepts for understanding what it means to know as patients in spaces of (chronic) self-care, innovation, and activism. [ABSTRACT FROM AUTHOR]

The #WeAreNotWaiting movement is a global digital health phenomenon in which people with diabetes, mainly type 1 diabetes (T1D), engage in the development and usage of open-source closed-loop technology for the improvement of their "chronic living" (Wahlberg et al. 2021). The characteristics of a digitally enabled and technologically engaged global activist patient collective feed into existing narratives of user-led and open-source innovation. They also call for more exploration of what it actually means to be locally involved in this kind of technologically mediated and global form of patient engagement. Building on empirical research conducted in the German healthcare context, we explore the different forms of material participation encountered among a group of people with T1D (who describe themselves as loopers), who are engaged in the development and usage of this open-source technology. Introducing the concept of device activism, we retrace three different device-centered narratives that show how a globally shared concern and political participation through technology use varies with local practices. Hereby we stress that the engagement in the #WeAreNotWaiting movement is both shaped by and is shaping the matters of concerns: devices in, on, and with bodies. [ABSTRACT FROM AUTHOR]

The article offers information on the ethics of mHealth as a global phenomenon, focusing on the wide implementation of mHealth technologies in many countries. Topics include the impact of smartphones on health data sharing, the endorsement of mHealth by political and industrial stakeholders, and the ethical implications of mHealth on individual, societal, and global scales.

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Femtech technologies, such as period and fertility trackers, promise their users empowerment through reliable knowledge about and control over their bodies and ownership of their procreative health. However, the notion of empowerment through period and fertility apps deserves scrutiny. Based on a thematic analysis of a range of 'female health' app promotion materials, we explore the kind of empowerment promised by app providers and point towards significant contradictions and tensions in the discursive tales of empowerment. Building on digital sociology and intersectional feminist scholarship, we observe that the discourse promoting many of the health apps is grounded in exclusionary ontologies, normative femininity, epistemic injustice and heterosexist notions of female sexuality, which undermines the liberational rhetoric of these digital health technologies. [ABSTRACT FROM AUTHOR]

The article focuses on ethicist who aims to achieve a practical impact needs to consider how to translate ethical norms into practice. Topic include based on implementation science: the science that is concerned with the promotion of the uptake of consolidated health research findings into routine healthcare practice and health policy.

The author argues the lack of sufficient guidance on how ethical norms are translated into interventions in the framework based on implementation science suggested by B. Sisk et al. The framework is based on the Consolidated Framework for Implementation Research by Damschroder and others. It explains the concept of advance care planning as a systematic approach to developing and delivering ethical interventions.