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In this article the concepts of statist medicine and subaltern therapeutics are used to provide insight into the debates over the therapeutic use of marijuana in cases of serious or terminal illness. In 2015 medical marijuana gained public attention in Aotearoa New Zealand as cases of people facing life-threatening conditions who wished to use marijuana for therapeutic purposes were given voice in the popular media. In Aotearoa New Zealand marijuana use is illegal for recreational purposes, but theoretically patients with particular conditions could gain access to medicinal forms of marijuana if health professionals, the Ministry of Health and the relevant government minister approved. This approval process is embedded within statist medicine's regulatory regimes, where access can be provided on condition that the medication meets standards of safety and efficacy. Patients faced with the difficulty of negotiating the processes of statist medicine to access medical marijuana often reverted to illegal means of accessing the plant. Access to illegal forms of marijuana for medical purposes could be through 'green fairies', people who provided the plant for therapeutic purposes in a way that was distant from the criminalised recreational use of the drug obtained through 'dealers'. The process of the state, patients and marijuana providers negotiating the regulation of therapeutic uses of marijuana provides insights into the role of statist medicine and subaltern therapeutics. The case of medical marijuana alerts us to the possibilities of other subaltern therapeutic practices that operate beyond the gaze of the state. [ABSTRACT FROM AUTHOR]

This study identified ways in which patients and medical specialists negotiated decisions about cancer treatment by observing decision-making discussion in situ. Audio-recordings of cancer care consultations with 18 patients, their support people, and their medical specialists, including medical oncologists, radiation oncologists and surgeons were collected in different regions of New Zealand. Patients were followed up with interviews and specialists provided consultation debriefings. The interpretation of the data drew on the concepts of epistemic and deontic rights to argue that in complex consultations, such as occur in cancer care, we need to reconsider the simple dichotomy of preferred consultations styles as paternalistic or based on shared decision-making. Decision-making is a dynamic process with specialists and patients linked into networks that impact on decision-making and where rights to knowledge and rights to decision-making are interactionally negotiated. The level of information and understanding that patients desire to exercise rights needs to be reconsidered. [ABSTRACT FROM AUTHOR]

Cityscapes comprise intense repositories for socio-economic interactions, including those surrounding medicinal products. This raises issues of pharmaceuticalisation, involving the construction of a range of human conditions as targets for pharmaceutical interventions. Employing the metaphoric figure of the flâneur, we traverse the New Zealand cityscape, interrogating the mediation and emplacement of various medicinal products within thoroughfares, commercial sites and domestic dwellings. We demonstrate the pharmaceuticalised commodification of the city and interpolation of urbanites as citizen-consumers. [ABSTRACT FROM AUTHOR]

Objectives: To explore factors potentially influencing equitable access to elective surgery in New Zealand by describing clinicians' perceptions of equity and the factors they consider when prioritising patients for elective surgery. Methods: A qualitative study in selected New Zealand localities. A purposive sample of 49 general practitioners, specialists and registrars were interviewed. Data were analysed thematically. Results: General practitioners described unequal opportunities for patients to access primary and secondary care and, in particular, private sector elective surgery. They felt that socio-economically disadvantaged patients were less able to advocate for themselves and were more vulnerable to being lost to the elective surgical booking system as well as being less able to access private care. Both GPs and secondary care clinicians described situations where they would personally advocate for individual patients to improve their access. Advocacy was related to clinicians' perceptions of the 'value' that patients would receive from the surgery and patients' needs for public sector funding. Conclusions: The structure of the health system contributes to inequities in access to elective care in New Zealand. Subjective decision making by clinicians has the potential to advantage or disadvantage patients through the weighting clinicians place on socio-demographic factors when making rationing decisions. Review of the potential structural barriers to equitable access, further public debate and guidance for clinicians on the relative importance of socio-demographic factors in deciding access to rationed services are required for allocation of services to be fair. [ABSTRACT FROM AUTHOR]

Objectives: To describe the ways patients access elective surgery in New Zealand, and to understand the use of, and attitudes to, clinical priority assessment criteria (CPAC) in determining access to publicly funded elective surgery. Methods: A qualitative study in selected New Zealand localities. A purposive sample of general practitioners, surgeons and administrators in publicly funded hospitals were interviewed. Data were analysed by a process of thematic analysis. Results: Sixty-five interviews were completed. General practitioners had a key role in determining which patients were seen in the public sector and, by utilising strategies to actively advocate for patients, influenced both waiting times for first assessment by surgeons and for surgery. CPAC had been developed as decision support guides with the intention that they would provide transparency and equity in determining access. However, there was variation in the way CPAC were being used both in score construction and in the influence of the score on access to surgery. The management of the hospital system also limited the extent to which CPAC could be used to prioritise patients for surgery. Conclusions: Variability in the use of CPAC tools meant that at the time of the study they did not provide a transparent and equitable method of determining access to surgery. This highlights the difficulties in developing and implementing CPAC and suggests that further development is difficult in the absence of evidence to identify patients who will benefit the most from surgery. [ABSTRACT FROM AUTHOR]

The medical profession in many industrialized nations has increasingly been subjected to accountability measures, most notably through the development of quality assurance programmes for practitioners. In New Zealand this development has been enshrined in law under the Medical Practitioners Act 1995. This article looks at some of the concerns raised by these developments, particularly focusing on the ways this might affect practitioners using alternative therapies. From an examination of the debates around accountability in medical practice, and interviews with practitioners who use alternative therapy, three models of medical practice are proposed. These models suggest that medical practices reflect worldviews that revolve around the way relationships between the medical profession, the practitioner, the patient and the patient's condition are perceived. [ABSTRACT FROM AUTHOR]

In anglophone countries, there have been increasing efforts to vaccinate the total population. A number of strategies have been employed in order to achieve this goal, including compulsory vaccination before children can attend school (USA); financial incentives to general practitioners and other vaccinators to achieve vaccination targets (UK); and, in New Zealand, a system known as mandatory choice. The New Zealand system involves education centres being co-opted into the medical domain to encourage parents to vaccinate their children. In order to promulgate such strategies, 'vaccinepreventable' diseases, vaccines, parents of unvaccinated children, and the children themselves are represented in particular ways. This paper examines the last three 'epidemics' of measles in New Zealand and the way in which the campaigns to prevent these epidemics represented the disease and other agents. Drawing on Foucault's concepts of governmentality and bio-power, the paper explores the linkages between disease representations and the state. In anglophone countries, there have been increasing efforts to vaccinate the total population. A number of strategies have been employed in order to achieve this goal, including compulsory vaccination before children can attend school (USA); financial incentives to general practitioners and other vaccinators to achieve vaccination targets (UK); and, in New Zealand, a system known as mandatory choice. The New Zealand system involves education centres being co-opted into the medical domain to encourage parents to vaccinate their children. In order to promulgate such strategies, 'vaccinepreventable' diseases, vaccines, parents of unvaccinated children, and the children themselves are represented in particular ways. This paper examines the last three 'epidemics' of measles in New Zealand and the way in which the campaigns to prevent these epidemics represented the disease and other agents. Drawing on Foucault's concepts of governmentality and... [ABSTRACT FROM AUTHOR]

This note presents a case study of the 1984 ICI chemical fire—a major New Zealand occupational health and safety incident. Details are presented of various health and illness disputations that arose after the fire and the way these tended to coalesce into lay and expert factions. Not wishing to treat lay/expert as a fixed dichotomy, we use the term 'partial connections' to emphasise that lay or expert knowledge is a socially accomplished and precarious element of actor-networks. Nevertheless, once these elements are made more durable, 'harder' social outcomes result, and in the case of the ICI fire the 'hard' facts tended to disfavour the lay actors and their knowledge. [ABSTRACT FROM PUBLISHER]