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Evidence Challenges, Commercialization, and the Market for Hope

Available Open Access digitally under CC-BY-NC-ND licence.

This book delves into the complex and controversial realm of fertility care. It analyses the clash between evidence-based medicine and market dynamics in fertility treatments, with a unique focus on "add-on" treatments. It reveals how these contentious treatment options are now common practice and how they lead to an emerging market for hope.

With an interdisciplinary approach, this is an essential resource for readers in the fields of science and technology studies and medical sociology.

Open access

The Conclusion underscores the significance of promoting responsible innovation within the field of fertility care. It raises concerns regarding the use of the concept of informed choice in context where evidence is lacking and information transparency is not guaranteed, discussing its impact on decision-making processes. Moreover, the chapter explores the regulatory challenges faced by the field and advocates for exploring various forms of corporate responsibility among stakeholders in biomedical innovation. Finally, it considers the broader implications of the growing commercialization of healthcare beyond the field of fertility care.

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Chapter Two explores the complexities surrounding evidence in fertility care. It begins by examining the relationship between evidence-based medicine and fertility care, discussing the challenges of generating evidence in a highly commercialized sector. It highlights the premises for rapid innovation, based on the common understanding that the absence of evidence does not imply the evidence of absence of effectiveness. Furthermore, it discusses the delicate balance between the time needed to establish robust evidence and the urgency of providing care, further propelling innovation. In conclusion, the chapter explores patients’ perspectives on evidence, shedding light on their diverse views and concerns.

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Chapter Three explores the intricate dynamics of the fertility market, analysing its multifaceted nature where medical assistance, innovation hype, and hope converge with significant ramifications. It offers a detailed examination of the marketing strategies employed in promoting biomedical innovation and contextualizes treatment decision-making within the framework of the hope market. Furthermore, it sheds light on the appeal of these treatments, rooted in their potential to support individuals in achieving their aspirations for parenthood, even in the absence of solid evidence. Finally, the chapter presents scholarly insights into the intricate process by which individuals navigate the complex landscape of informed choice amidst the compelling allure of hope.

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The introduction sets the stage for exploring fertility treatment add-ons, showcasing them as a prime example of biomedical innovation in fertility care. It traces the rapid evolution of the field, from the groundbreaking start of in vitro fertilization (IVF) to fertility care becoming a routine treatment. Additionally, it outlines the impact of limited public funding on the commercialization of fertility care, revealing how this shapes the landscape of reproductive medicine worldwide. Lastly, by presenting the concept of the ‘hope market’, the introduction sheds light on the characteristics of a market driven by emotive factors rather than purely economic ones. This lays the groundwork for exploring the broader socio-cultural factors at play in this field.

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Chapter Four navigates the crucial realm of regulating a market driven by hope. It meticulously examines the complexities of regulating medical innovation within fertility care, underscoring the importance of fairness in disseminating information to facilitate informed decision-making. The chapter explores pricing strategies and their impact on the affordability of fertility treatments, shedding light on the challenges faced by individuals seeking access to these services.

Open access

Chapter One provides an overview of fertility treatment add-ons. It starts by defining what these add-ons entail and then examines the HFEA add-on rating system, exploring the perspectives of both patients and professionals. The chapter addresses the financial aspect by discussing the costs associated with treatment add-ons. Moreover, it scrutinizes the criteria used to classify interventions as treatment add-ons from the viewpoints of patients and professionals alike. Lastly, it challenges conventional assumptions about treatment add-ons, prompting readers to reconsider their understanding of these interventions.

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This closing chapter discusses the public accountability of social media platforms that have eluded policymakers. We discuss the challenges in detection and mitigation of misinformation that emerged in the Brexit debate on social media. We also discuss the growing perception that social networking sites are opaque platforms unaccountable to regular users and governments alike, with sentiments towards Twitter bots and trolls often taking centre-stage. We argue that social media algorithms, in particular Facebook and YouTube recommendation engines, remain largely unaccountable to public scrutiny and that the criteria underpinning algorithmic decisions on which news stories are distributed to users are intellectual property deemed commercially sensitive and therefore inaccessible to the public.

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This chapter unpacks the activity patterns of a group of 13,493 bot-like Twitter accounts that tweeted the Brexit referendum and disappeared from the platform shortly after the ballot. The Brexit Botnet comprises 5 per cent of the userbase that tweeted the referendum campaign, a group of users that was removed from the platform by Twitter moderators. The Brexit Botnet sheds considerable light on the weaponization of social media platforms that was central to the referendum campaign, while also exposing the role of algorithms in which bots feature as the most simple, cost-effective, and flexible approach to gaming the social media attention economy. The chapter concludes with a discussion of the policy developments in the aftermath of various congressional and parliamentary inquiries into foreign interference in national elections leveraging bots, trolls, and sockpuppet accounts to weaponize social media.

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The book explores a data set of 45 million tweets about Brexit posted by a quarter of a million British users. This database was collected in real time and on a rolling basis to monitor the activity of a cohort of users we identified as the British Twitter Monthly Active Userbase. The data include posts from April 2016, the official start of the campaign period, until the end of January 2021, when the United Kingdom left the European Union. We take stock of emerging trends in the data pointing towards epochal changes in partisan politics, including the political realignment towards nationalist and populist values, but also broader societal changes feeding into polarization and echo-chamber communication. The book also provides an account of how social media manipulation emerged to national and then international attention in the run up to the referendum campaign and in the wake of the Cambridge Analytica data scandal, including a detailed account of techniques employed to interfere and potentially distort the public discussion. The book closes with an analysis of the precarity and ephemerality of social media register, as nearly one-third of messages tweeted about Brexit disappeared from the public domain in the following years.

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