Cancer: it's time to change the sign

Downar, James

doi:10.1503/cmaj.100235

“…If they respond and the cancer remits, they are called "survivors" (a term of victory) (Downar 2010) In this narrative, advocates positioned CBA within the 'battleground' in which patients engaged in a zero-sum (win/lose) 'fight to the death' against cancer, and Pharmac's refusal to fund the treatment "promoted as the magic bullet" to cure HER2+ breast cancer (Women's Health Action…”

Section: Pharmac As Cancer's Collaborator "I'm Looking At Everything I Possibly Can To Fight This" (M002)mentioning

confidence: 99%

No More Than Comfort? A logics approach to the 'grip' of cost-benefit analysis in a New Zealand public policy decision

Markham¹

0

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<p>This study explores an apparent paradox: cost-benefit analysis (CBA) requires a series of highly subjective decisions to calculate, yet is employed for its perceived objectivity. The dominant view of CBA in the academic and policy literature is as a neutral technology, offering an objective resolution to difficult resource allocation problems. However, this view has been much challenged, with long-standing and still-unresolved debates on CBA’s technical calculation and methodological approaches, as well as critiques of its underpinning socio-political assumptions and its consequences. Drawing on the literature considering accounting as a form of discourse, this study investigates CBA and its discursive use in the debate between 2006 and 2008 around the public policy decisions regarding New Zealand’s public funding of Herceptin (trastuzumab) for early HER2-positive breast cancer (‘the debate’). The repeated use of cost and CBA in arguments by the participants in this debate was striking, with both those for and those against funding appearing to regard CBA as especially authoritative. This authority – even dominance – of CBA in public policy decision-making has been addressed from several perspectives, but its affective (embodied, emotional, non-cognitive) dimensions remain under-explored. This study addresses that gap through a qualitative documentary analysis employing the post-structural critical discourse-theoretic approach of Glynos and Howarth’s Logics of Critical Explanation (LCE) framework (Glynos, J., & Howarth, D. (2007). Logics of Critical Explanation in Social and Political Theory. Abingdon, Oxon: Routledge). It offers the following contributions: (a) it provides knowledge of how CBA is presented, positioned, contested, and defended in the Herceptin debate; (b) it generates a genealogically-inflected understanding of how these have come about; (c) its offers an explanation for CBA’s ‘grip’ (continued authority despite its difficulties); and (d) it proposes some alternative presentations, positionings, contestations, and defences of CBA.</p>

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“…If they respond and the cancer remits, they are called "survivors" (a term of victory) (Downar 2010) In this narrative, advocates positioned CBA within the 'battleground' in which patients engaged in a zero-sum (win/lose) 'fight to the death' against cancer, and Pharmac's refusal to fund the treatment "promoted as the magic bullet" to cure HER2+ breast cancer (Women's Health Action…”

Section: Pharmac As Cancer's Collaborator "I'm Looking At Everything I Possibly Can To Fight This" (M002)mentioning

confidence: 99%

No More Than Comfort? A logics approach to the 'grip' of cost-benefit analysis in a New Zealand public policy decision

Markham¹

0

View full text Add to dashboard Cite

<p>This study explores an apparent paradox: cost-benefit analysis (CBA) requires a series of highly subjective decisions to calculate, yet is employed for its perceived objectivity. The dominant view of CBA in the academic and policy literature is as a neutral technology, offering an objective resolution to difficult resource allocation problems. However, this view has been much challenged, with long-standing and still-unresolved debates on CBA’s technical calculation and methodological approaches, as well as critiques of its underpinning socio-political assumptions and its consequences. Drawing on the literature considering accounting as a form of discourse, this study investigates CBA and its discursive use in the debate between 2006 and 2008 around the public policy decisions regarding New Zealand’s public funding of Herceptin (trastuzumab) for early HER2-positive breast cancer (‘the debate’). The repeated use of cost and CBA in arguments by the participants in this debate was striking, with both those for and those against funding appearing to regard CBA as especially authoritative. This authority – even dominance – of CBA in public policy decision-making has been addressed from several perspectives, but its affective (embodied, emotional, non-cognitive) dimensions remain under-explored. This study addresses that gap through a qualitative documentary analysis employing the post-structural critical discourse-theoretic approach of Glynos and Howarth’s Logics of Critical Explanation (LCE) framework (Glynos, J., & Howarth, D. (2007). Logics of Critical Explanation in Social and Political Theory. Abingdon, Oxon: Routledge). It offers the following contributions: (a) it provides knowledge of how CBA is presented, positioned, contested, and defended in the Herceptin debate; (b) it generates a genealogically-inflected understanding of how these have come about; (c) its offers an explanation for CBA’s ‘grip’ (continued authority despite its difficulties); and (d) it proposes some alternative presentations, positionings, contestations, and defences of CBA.</p>

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