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

This paper draws parallels between the market trend in the English NHS and Polanyi's (1957) The Great Transformation: The political and economic origins of our time, Beacon Press: Boston (originally published in 1944 in the United States as The Great Transformation, Rinehart: and Co: New York, and in 1945 in England as Origins of our time, Gollancz: London) account of how the rise of markets provokes a self-protective counter-reaction that tries to re-embed economic relations in social relations. We report findings from a qualitative study of NHS contracting, which examines the recent move to harder-edged contracts with greater use of financial penalties and incentives. In practice, use of these techniques tended to be confined to nationally-mandated sections of the contract rather than emerging from local bilateral agreements, and when things went wrong the parties relied more on cooperative behaviour than on the provisions of the contract to find solutions. Making the current contracting system work depended more on existing relational networks than on the incentive structures created by recent 'marketisation' initiatives, but the inability of the market to evolve as expected has encouraged policy makers to publish plans for further radical reforms. [ABSTRACT FROM AUTHOR]

There are five times as many DNA paternity tests per capita in the US than Australia. This is not a consequence of 'technological lag', but a combination of political, cultural and economic factors. First, government agencies in the US enforce relatively more tests, at least partly because of legislative differences in the presumption of paternity. Second, government agencies in the US enforce relatively more tests partly on account of differences in family structure. More specifically, in the US there are relatively more nonmarital births, and nonmarital births are less likely to occur in the context of informal cohabitation where paternity is not in dispute. Third, differences in industry organisation account for more DNA paternity tests per capita in the US. Unlike the Australian market, the US market is characteristically divided between tests done for government agencies and those for private individuals. In turn, the private market in the US is more competitive. In particular, brokerage is pervasive, leading to more proactive marketing through the Internet, day-time television and other avenues. The study highlights the importance of social dynamics in the uptake of new technologies. [ABSTRACT FROM AUTHOR]