Accidents and Apathy: The Construction of the 'Robens Philosophy' of Occupational Safety and Health Regulation in Britain, 1961-1974.

The 1972 Robens Report is widely regarded to have provided the underlying rationale for the 'modern' system of occupational health and safety regulation in Britain, embodied in the Health and Safety at Work Act (HSW Act) 1974. The HSW Act advanced a new, more flexible system of regulation, premised on the ideal of self-regulation by industry. This article advances a more nuanced historical understanding of the Report and its ethos-the 'Robens philosophy'-than hitherto developed, situating its assumptions about accidents, regulation and the role of the state in the social, economic and political context of Britain in the 1960s and early 1970s. Highlighting the interaction between these trends and long-established regulatory practices, the article argues that the turn to 'self-regulation' heralded by the Robens Report was highly convincing from a political and regulatory perspective at the time it was promulgated

World health by place: the politics of international health system metrics, 1924-c. 2010.

This article examines the development of health system metrics by international organizations, exploring their relationship to the politics of world health. Current historiography treats measurement either as progressive illumination or adopts a critical stance, viewing indicators as instruments of global governance by powerful nations. We draw on diverse statistical publications to provide an empirical overview of change and continuity, beginning with the League of Nations Health Organization, which initiated health system statistics, and concluding with the World health report 2000, with its controversial comparative rankings. We then develop analysis and explanation of these trends. Population indicators appeared consistently owing to their protective function and compatibility with development thinking. Others, related to provision, financing, and coverage, appeared more sporadically, owing to changing trends and assumptions in international health. While partly affirming the critical literature, metrics were also used by peripheral or resistant actors to challenge or influence policy at the centre

Requirements for Aggression: Altering EAAT 1 Expression To Manipulate Glutamate Uptake in Drosophila Melanogaster

Aggression is a behavior required for survival and reproduction. Research has identified several neurons and neurotransmitters (signaling molecules) that are important for promoting aggression, but the neurotransmitter glutamate has only recently been identified, and its role is not fully understood. This research examines how manipulation of glutamate expression via altered expression of its transporter, EAAT1, alters aggression in the Drosophila model organism. Glutamate function was reduced by increasing expression of the glutamate transporter, EAAT1 (Excitatory Amino Acid Transporter 1). EAAT1 recycles extracellular glutamate to regulate neuronal communication. By increasing the amount of EAAT1, more glutamate is recycled, reducing its ability to signal to the downstream neuron. EAAT1 expression was increased via controlled transgenic expression. Conversely, glutamate function was increased by reducing expression of EAAT1 via RNA interference. Using genetic tools and antibody labeling, it was verified that EAAT1 is widely expressed in glial cells throughout the brain. A reduction in glutamate produced male flies that were less aggressive compared to controls, similar to previous research that manipulated glutamate expression only in octopamine neurons. Specifically, experimental flies took longer to start fighting, lunged less, and produced fewer wing threats and wing extensions. Flies with increased glutamate levels were also less aggressive, though this may be due to limited function at the neuron or the neuromuscular junction, where a motor neuron and a muscle fiber meet. These results demonstrate glutamate function is required for sex-specific behavior and provide a foundation to determine the role of glutamate in aggression circuitry in any system

Enzyme replacement therapy for Fabry disease: some answers but more questions

Fabry disease (FD) is a multisystem, X-linked disorder of glycosphingolipid metabolism caused by enzyme deficiency of α-galactosidase A. Affected patients have symptoms including acroparesthesias, angiokeratomas, and hypohidrosis. More serious manifestations include debilitating pain and gastrointestinal symptoms, proteinuria and gradual deterioration of renal function leading to end-stage renal disease, hypertrophic cardiomyopathy, and stroke. Heterozygous females may have symptoms as severe as males with the classic phenotype. Before 2001, treatment of patients with FD was supportive. The successful development of enzyme replacement therapy (ERT) has been a great advancement in the treatment of patients with FD and can stabilize renal function and cardiac size, as well as improve pain and quality of life of patients with FD. In this review, we have provided a critical appraisal of the literature on the effects of ERT for FD. This analysis shows that data available on the treatment of FD are often derived from studies which are not controlled, rely on surrogate markers, and are of insufficient power to detect differences on hard clinical endpoints. Further studies of higher quality are needed to answer the questions that remain concerning the efficacy of ERT for FD

Agalsidase alfa versus agalsidase beta for the treatment of Fabry disease: an international cohort study

BACKGROUND: Two recombinant enzymes (agalsidase alfa 0.2 mg/kg/every other week and agalsidase beta 1.0 mg/kg/every other week) have been registered for the treatment of Fabry disease (FD), at equal high costs. An independent international initiative compared clinical and biochemical outcomes of the two enzymes. METHODS: In this multicentre retrospective cohort study, clinical event rate, left ventricular mass index (LVMI), estimated glomerular filtration rate (eGFR), antibody formation and globotriaosylsphingosine (lysoGb3) levels were compared between patients with FD treated with agalsidase alfa and beta at their registered dose after correction for phenotype and sex. RESULTS: 387 patients (192 women) were included, 248 patients received agalsidase alfa. Mean age at start of enzyme replacement therapy was 46 (±15) years. Propensity score matched analysis revealed a similar event rate for both enzymes (HR 0.96, P=0.87). The decrease in plasma lysoGb3 was more robust following treatment with agalsidase beta, specifically in men with classical FD (β: -18 nmol/L, P<0.001), persisting in the presence of antibodies. The risk to develop antibodies was higher for patients treated with agalsidase beta (OR 2.8, P=0.04). LVMI decreased in a higher proportion following the first year of agalsidase beta treatment (OR 2.27, P=0.03), while eGFR slopes were similar. CONCLUSIONS: Treatment with agalsidase beta at higher dose compared with agalsidase alfa does not result in a difference in clinical events, which occurred especially in those with more advanced disease. A greater biochemical response, also in the presence of antibodies, and better reduction in left ventricular mass was observed with agalsidase beta

Risk, Responsibility and Robens: The Transformation of the British System of Occupational Health and Safety Regulation, 1961–1974

Over the last twenty years, three short words have come to dominate many discussions about the control of risks: ‘health and safety’. In colloquial use, the term embodies a multitude of concerns about the impact of everyday actions on the bodies and minds of individuals; it also commonly conflates what are often separate areas of statutory regulation, particularly road safety, food safety and environmental regulations. Together with two other words often uttered in the same sentence, ‘gone mad’, ‘health and safety’ is often used as a kind of shorthand for bureaucracy, and the whole gamut of rules and regulations that have evolved in response to the risks of everyday life

Taking action against medical accidents : a brief history of AvMA and clinical risk management in the NHS

Established in 1982, Action against Medical Accidents (AvMA)—originally named Action for Victims of Medical Accidents—was effectively the first charity in Britain dedicated to ‘patient safety’. This article provides a historical analysis of the origins and work of AvMA, situating its background in the medical negligence ‘crisis’ of the 1970s and 1980s, growing consumerism in healthcare, and the significant barriers to justice patients confronted following a clinical incident. It also explores AvMA's impacts on evolving attitudes towards patient harm and safety in the NHS. The article asserts that in addition to supporting patients and campaigning for changes in legal procedures, AvMA played an instrumental role in raising the political profile of adverse health events (‘medical accidents’). By supporting claimant solicitors and increasing their chances of legal success, AvMA contributed to the rising tide of negligence claims, which incentivised NHS trusts and health authorities to introduce clinical risk management (CRM). By 2000, CRM was being framed as part of a broader mission to improve quality and safety in healthcare, and AvMA was recognised as a key stakeholder in the new patient safety agenda

Health and Safety in the British Regulatory State, 1961-2001: the HSC, HSE and the Management of Occupational Risk

This thesis engages with recent historical scholarship on occupational health and safety by analysing the conditions that shaped the development of British health and safety regulation between 1961 and 2001. Drawing upon a rich vein of archival material as well as oral history interviews, the thesis focuses on the role played by two regulatory bodies, the Health and Safety Commission (HSC) and Health and Safety Executive (HSE), in generating and enforcing this framework of laws and standards. The thesis illuminates two major historical trends. Firstly, it explores the gradual transformation of the British state in its role as health and safety regulator. Since 1974, the focus of British regulation has been to promote ‘self-regulation’ by employers and employees, and the thesis analyses the ways in which HSC/E has attempted to foster a ‘safety culture’ in British industry, in the context of social, political and economic pressures. Secondly, the thesis analyses the evolution of risk in health and safety regulation, from implicit assumptions and practices in policymaking and enforcement, to the formal demand for all employers to conduct written risk assessments. In so doing, the thesis reconciles various paradoxes. One such paradox is that while the role of the British state in regulating health and safety has ostensibly ‘rolled back’ (e.g. via deregulation), health and safety has in another sense ‘crept forward’, extending beyond the workplace to intervene in public safety and environmental issues. Another paradox is that while British health and safety legislation has been ostensibly ‘successful’ in reducing fatal workplace accidents, it has come under unprecedented public and political scrutiny in recent years. Examining the evolution of health and safety against an extensive theoretical background (e.g. the ‘risk society’), 16 the thesis explains how health and safety has become increasingly central to our work and public lives

From "Planning" to "Systems Analysis" : Health services strengthening at the World Health Organisation, 1952-1975

This article discusses the early postwar history of international engagement with the strengthening of health services by the World Health Organisation (WHO). Standard narratives emphasise that the WHO prioritised vertical programmes against specific diseases rather than local capacity-building, at least until the Alma Ata Declaration of 1978 launched a policy focus on primary health care. There was, however, a longer lineage of advisory work with member states, and our aim is to examine this intellectual and policy history of health services planning and administration. We begin by surveying the relevant secondary literature, noting that this theme appears only briefly in the institution’s first official histories, with minimal contextualisation and analysis. We then proceed chronologically, identifying an early phase in the 1950s when, despite its marginalisation at the WHO, the interwar European social medicine tradition kept alive its ideals in work on health planning. However, the sensitivities of the USA and of the colonial powers meant that consideration of social security, health rights and universal coverage was absent from this discussion. Instead it was initially concerned with propounding Western models of organisation and administration, before switching to afocus on planning techniques as an aspect of statecraft. In the 1960s such practices became incorporated into economic development plans, aligning health needs with infrastructure and labour force requirements. However, these efforts were entangled with Western soft power,and proved unsuccessful in the field because they neglected issues of financing and capacity. In the 1970s the earlier planning efforts gave rise to a systems analysis approach. Though in some respects novel, this too provided a neutral, apolitical terrain in which health policy could be discussed, void of issues of rights and redistribution. Yet it too foundered in real-world settings for which its technocratic models could not account