Styles of thought in healthcare governance: A situational analysis of English PrEP discourse 2016–2020
Bibliographic record
Abstract
Attending to competing styles of thought in healthcare controversies may be helpful to critical health scholarship. This article reexamines the debate over the introduction of a new HIV prevention technology in England as a tension between epidemiological and molecular style of thoughts. I argue English HIV services were organised according to an epidemiological style of thought. The introduction of biomedical pre-exposure prophylaxis (PrEP) to the health system brought this rationality into question in ways the English health system was ill-prepared to manage. A situational analysis of English PrEP discourse in the lead up and following NHS-England's 'U-turn' on PrEP illustrates a split along epidemiologically and biomedically informed styles of thought. These networks have their dedicated administrators, experts, activists and ways of thinking about their target population and preferred organisation of HIV services. Though they often collaborate, these two groups have distinct moral and political agendas that relate to their style of thinking. This analysis further nuances existing critical interpretations of the PrEP controversy in England. Beyond England, this debate suggests a potential departure from the conventional biopolitical subject and rationality of advanced liberalism.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.017 | 0.019 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.012 | 0.021 |
| Scholarly communication | 0.012 | 0.010 |
| Open science | 0.001 | 0.008 |
| Research integrity | 0.002 | 0.004 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".