For many years, the orthodox model of medical innovation has been largely accepted. This model has largely assumed that new health technologies will be delivered through the ‘lengthy innovation process of basic research, clinical experimentation, product development, clinical trials, product approval and clinical application.' (Salter et al. 2015: 156). It has been disseminated as a hegemonic model through large transnational organisations who draw upon the ‘objective’ nature of the scientific method in order to gain legitimacy. This has further been sustained by the idea that health consumers have a passive role in scientific process by contributing only through clinical trials, and once the research process is complete, receiving clinical benefits.
However, as highlighted by Salter et al.(2015), the hegemonic model is increasingly being challenged, especially in the area of stem cell science. A counter-hegemonic force has developed in which consumers of scientific-unproven stem cell therapies (often called ‘stem-cell tourists’) have become more actively involved in the bio-medical innovation. These consumers are largely accepting the practice-based model, which is a direct challenge to the orthodox model. Rather than simply providing scientifically-generalisable results, the practice-based model offers benefits for the individual patient concerned.
The emergence of this counter-hegemonic force has gained the attention of hegemonic model’s traditional intellectuals, the bioethicists. They have largely supported the orthodox model of stem cell innovation, focusing more upon taking a neutral stance, rather than positively engaging with counter-hegemonic arguments. Ethical debates have thus largely revolved around the morality behind the creation and destruction of human embryonic stem cells, and how to formulate government policy in order to ensure that this area of science is able to advance. This has resulted in the global emergence of standardised policies to address such ethical concerns.
But, with the emergence of stem cell tourism, ethical concerns have shifted. Biomedical innovation has begun to take into account the demand side of the stem cell market, and thus looking at the rights of patients to seek treatment for their diseases. Gunter highlighted that ‘no entity should withhold this fundamental right unless there is a high probability of harm to the patient’ (2010: 966). The patient is finally becoming the primary focus of stem cell innovation governance with issues such as citizen rights and consumer access finally being included in clinical decisions-making.
This counter-hegemony has emerged in a field where the orthodox model has little control. Consumers are increasingly geographically mobile, and the demand-supply relationship has been dramatically reshaped due to the high accessibility of access available over the internet. The question over the next few decades is whether or not this counter-hegemony will maintain its place, and if consumer choice will continue to challenge the logic of orthodox science.
To read the full paper click here.