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British medical sociology emerged in the shadow of a publicly-funded National Health Service, and the need for evidence to support the development of policy and services. Although the initial focus was on applied problems, largely defined by the medical profession, a combination of permissive leadership in the early research centres and the desire of research administrators to widen research agendas, gave medical sociologists considerable latitude to developed distinctive research programmes. By the 1970s British medical sociologists were turning their attention to focused studies of interaction in health care settings, on the one hand, and professional power, structural interests, social disadvantage and gender, on the other. But this shift from applied empirical research to studies that drew more explicitly on sociological theory was halted and even reversed as the research funding climate changed, and the emphasis shifted to large multi-site, multi-disciplinary studies. While the ESRC still supports some basic social scientific research and medical sociologists also find work in multidisciplinary projects examining contemporary problems, sociological concepts are increasingly likely to be blended with concepts from other disciplines in final reports. British medical sociology is no longer an infant sub-discipline, but it still remains in many ways a marginal enterprise, uncertain of its identity and its place in the health research division of labour.

British medical sociology emerged in the shadow of a publicly-funded National Health Service, and the need for evidence to support the development of policy and services. Although the initial focus was on applied problems, largely defined by the medical profession, a combination of permissive leadership in the early research centres and the desire of research administrators to widen research agendas, gave medical sociologists considerable latitude to developed distinctive research programmes. By the 1970s British medical sociologists were turning their attention to focused studies of interaction in health care settings, on the one hand, and professional power, structural interests, social disadvantage and gender, on the other. But this shift from applied empirical research to studies that drew more explicitly on sociological theory was halted and even reversed as the research funding climate changed, and the emphasis shifted to large multi-site, multi-disciplinary studies. While the ESRC still supports some basic social scientific research and medical sociologists also find work in multidisciplinary projects examining contemporary problems, sociological concepts are increasingly likely to be blended with concepts from other disciplines in final reports. British medical sociology is no longer an infant sub-discipline, but it still remains in many ways a marginal enterprise, uncertain of its identity and its place in the health research division of labour.

The innovative pharmaceutical industry employs thousands of people in Quebec and so has the ability to exert strong political pressure; the public statements of Sanofi-Aventis concerning the provincial reimbursement of certain expensive drugs are an example. "Maintaining a dynamic biopharmaceutical industry" is one of four main axes of the drug policy of Quebec's ministry of health. However, this role of government should not take precedence over the efficient and equitable management of health resources. We defend the legitimate and responsible choice of the Institut national d'excellence en santé et en services sociaux du Québec (INESSS) to require an acceptable cost-effectiveness ratio from expensive new drugs.

Résumé Objectif : Parmi les nouveaux médicaments anticancéreux, certains ont un prix très élevé et apportent peu de bénéfices par rapport à leur coût. Il existe une variation de couverture de ces médicaments entre les régimes publics provinciaux canadiens. Dans cette étude comparative exploratoire, nous cherchons à relever les différences de couverture pour des raisons de coût-bénéfice et à identifier des éléments structuraux favorisant une couverture publique des anticancéreux à la fois accessible, efficiente et équitable. Méthodes : Nous avons analysé et comparé les décisions de remboursement du Québec, de l'Ontario et de la Colombie-Britannique. Nous avons aussi analysé et comparé les agences d'évaluation et les régimes publics d'assurance médicaments de ces trois provinces. Nous nous sommes penchés sur les critères d'admissibilité aux régimes et aux contributions financières demandées. Résultats : La couverture des anticancéreux onéreux est plus étendue en Ontario et en Colombie-Britannique qu'au Québec. Cependant, sur le plan de l'évaluation des anticancéreux en Colombie-Britannique, l'agence travaille isolément du reste du système de santé, manque de transparence et de distance par rapport au monde de l'oncologie. Sur le plan des régimes d'assurance médicaments, la prime de base au Québec répartit une part du fardeau financier sur l'ensemble des assurés. En modulant les contributions en fonction du revenu, le régime ontarien est plus progressif. La Colombie-Britannique assure l'accès gratuit aux anticancéreux mais au prix d'une iniquité envers les autres groupes de malades qui doivent payer une contribution pouvant aller jusqu'à 4 % de leur revenu familial brut. Conclusion : En matière d'anticancéreux, la Colombie-Britannique se présente comme la meilleure pour l'accès. Cependant, les conditions dans lesquelles se prennent les décisions favorisent indûment l'accès au détriment de l'efficience et l'équité. Prat Organ Soins. 2012;43(1):9-18

Among all categories of health expenditure in Canada, spending on drugs is the fastest growing. The factors at play in the increase in expenditure on drugs are essentially those related to the volume of use and the arrival of new drugs on the market. Some of these new drugs are very expensive. In fact, the costs of certain drugs threaten the continued existence of the Québec Prescription Drug Insurance Plan. In Québec, the Conseil du médicament (Drug Board) is responsible for recommending drugs to the Ministry of Health and Social Services to be put on the formulary of drugs covered by the public plan. In spite of pressure by various stakeholders, we believe that the rationing of drugs that are too expensive can achieve political legitimacy if it is based on a transparent justification that includes not only evidence-based criteria, but also ethical principles and values. For egalitarians, fairness in the supply of health care should be accomplished as a function of health care needs. But this concept of justice should also be extended to future generations. The balance of current and future needs should be achieved by determining what would be "reasonable access" through public consultations among experts and citizens.

Medical sociologists who suggest that some form of interactional control can be seen to operate in medical consultations frequently relate `control' to the doctor's use of strategies which resist challenges to his professional authority and prevent patients from increasing their influence on decisions affecting treatment and disposal. This paper argues that much of the interactional `work' discernable in the encounter is concerned less with the management of conflict than with accomplishing the production of orderly and topically relevant sequences of talk in a situation in which one co-participant has only limited competence in relating talk to a body of specialist knowledge.

Introduction: Hope and uncertain hope -- Wind on land -- How not to fight a wind farm -- The Eden problem -- Energy without stories -- Turbine sublime -- Landscapes of wheat of war -- Vigilance, the new mood of energy -- Latifundios of air -- Just sacrifice, an experiment -- Conclusion: Wind, justice, and compromise.

'In Energy without Conscience' David McDermott Hughes investigates why climate change has yet to be seen as a moral issue. He examines the forces that render the use of fossil fuels ordinary and therefore exempt from ethical evaluation. Hughes centers his analysis on Trinidad and Tobago, which is the world's oldest petro-state, having drilled the first continuously producing oil well in 1866. Marrying historical research with interviews with Trinidadian petroleum scientists, policymakers, technicians, and managers, he draws parallels between Trinidad's eighteenth- and nineteenth-century slave labor energy economy and its contemporary oil industry. Hughes shows how both forms of energy rely upon a complicity that absolves producers and consumers from acknowledging the immoral nature of each. He passionately argues that like slavery, producing oil is a moral choice and that oil is at its most dangerous when it is accepted as an ordinary part of everyday life.

The art of belonging -- Engineering and its redemption -- Owning Lake Kariba -- Hydrology of hope -- Playing the game -- Belonging awkwardly