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The sociology of diagnosis has shown that diagnosis not only serves to label the underlying cause of disease but also to provide access to services and resources. Elaborating on this double‐affordance of diagnosis, this article examines how precision medicine reconfigures diagnosis as a label and as a process in regulatory and clinical settings. Reporting from an ethnographic case study of the introduction of immunotherapy for lung cancer, the paper unfolds the uncertainties involved in dissecting diagnosis into layers and examines the efforts and negotiations it takes to enable these layers to work both as clinical entities and regulative entities with the purpose of delineating access to treatment. I suggest that the work of subdividing diseases into molecularly defined categories for the purpose of delineating treatment‐eligible populations can be labelled 'diagnostic sub‐stratification' and argue that it is pertinent to understand the political capacity of this strategy. Diagnostic sub‐stratification involves a push of diagnosis from the clinic 'up' into the regulatory system and 'out' into the laboratories, obscuring who is accountable for the diagnostic categories employed to define patients' treatment access. [ABSTRACT FROM AUTHOR]

Classical dilemmas of how to distribute limited resources have been rekindled by the rise of advanced, high‐cost therapies. Building on a case study of a novel gene therapy in neuropaediatric care, this article explores the dilemmas that explicit priority setting can create for frontline professionals and develops a typology of professionals' responses to these dilemmas. Despite political attempts to centralise priority setting and spare health professionals from having to consider treatment costs at the 'bedside', this study shows that concern for economic efficiency and budget control nonetheless need to be handled and balanced against other accountabilities in the daily work of frontline professionals. Contributing to the sociological debate on priority setting and rationing, this study develops an analytical perspective attuned to the relational aspects of frontline work and the challenges related to the balancing of diverging ideas of good conduct. Further, focussing on an empirical field at the forefront of genomic medicine, this study brings the sociological debate on priority setting and rationing up to date with current developments in precision medicine. [ABSTRACT FROM AUTHOR]

Personalized medicine raises the stakes of pharmaceutical market regulation. Drawing on pragmatist valuation studies and science and technology studies literature on personalized medicine and pharmaceutical markets, this article demonstrates how complex negotiations about the value of a pharmaceutical can constitute a market in various ways, while also shaping the concerned patient populations. Tracing the path of a pharmacogenetic treatment, Spinraza, from its approval by the European Medicines Agency to its adoption in the publicly funded Danish healthcare system, we show how the market was formatted through particular stratifications of the patient population. We conceptualize these seemingly technical moves as strategies of stratification, that is, the application of techniques to assemble and divide data – and what data are meant to represent – into groups delineated by certain characteristics. We argue that stakeholders' use of strategies of stratification has important implications not only for market access, but also for the delineation of diseases and patient populations. Hence, it is crucial to make intelligible the mutual constitution of pharmaceutical markets and patient populations and the political efforts of delineating and connecting the two. [ABSTRACT FROM AUTHOR]

Management devices from industrial sectors are proliferating in the public sector, a trend now being accused of undermining the proper values of public organizations. A prominent example of such a management device is lean management, which is a set of principles and tools employed by contemporary management consultants to eliminate waste and promote value - often for the sake of efficiency. While lean management has been particularly welcomed in the healthcare sector, healthcare professionals are increasingly resisting attempts at leaning their work processes. Applying the notion of trials of valuation, this study empirically unfolds the conflicts arising when lean management is used to reorganize the task of distributing patients to beds in a children's hospital. Following the turn to value and the pragmatic tenet of studying values as the outcome of work, this paper suggests that the effects of a management device on the values of an organization can fruitfully be investigated for its ability to organize. Further, the paper contributes to the field of valuation studies with a heuristic to undertake such an investigation, directing attention towards the object of valuation, the temporal and spatial dimensions of the valuation situation, and the knowledge used to inform that valuation. [ABSTRACT FROM AUTHOR]

This paper is about the interplay between multiple modes of valuation. The paper engages with the question of how a valuation device intersects with the working values of an organization. While the many studies of valuation practices have drawn attention to the pervasive effects of valuation devices, only a few studies have taken into account the fact that many spaces, including organizations, are already filled with practices and ideas that constitute what is valuable. Revisiting classical organization theory, this paper shows that organizations comprise multiple, more—or less—integrated modes of valuation. Empirically, the paper draws on an ethnographic study of Lean management at a children's hospital, which is presented through analytical snapshots. The paper suggests that an organizational turn is relevant for valuation studies, as this first allows an analytical expansion to include less 'deviced' valuations, contributes to the ongoing culture vs. device debate offering an alternative to the causal analysis of devices and effects without making the 'ineffable culture' what makes or breaks the causality. [ABSTRACT FROM AUTHOR]

An increasing number of Danes are living, and dying, with cardiovascular disease. There is good evidence for the impact of cardiac rehabilitation on coronary heart disease, heart failure and symptomatic peripheral arterial disease. However, more high-quality research is needed into a wider range of cardiac diseases including rehabilitation following cardiac arrest, and palliative care for patients with advanced heart disease. In this review it is discussed how to improve the quality of care and identify the direction of future research and development.