This article addresses the question of how policymakers could deliberately influence processes of technology development. Using the development of wind turbines in Denmark as an example, the article describes the frames of meaning guiding the actions of those involved in the three subprocesses of policymaking, the generation of new technologies, and the management of the firms that bring new artifacts to the market. The three types of actors share an interest in one notion: the meaning of a technological artifact. This (...) notion, however, plays a different role in the respective frames of meaning of the actors. For policymakers and managers, it is an instrumental notion. For technologists, it provides guidance to their activities. The shared interest affords the possibility of reaching common action with only congruent meanings. Interactive forms of technology assessment can play a central role in bringing about such congruent meanings and thus in influencing the generation of new technologies. (shrink)

The Dutch animal production sector faces significant pressure for change. We discuss a project for the design of a sustainable husbandry system for pigs. Named after the Greek hero Hercules, the project aimed for structural changes in both animal and crop production. However, instead of changing the course of the river, the project ended up merely adapting its flow. The Hercules project ran into difficulties typical for projects aiming at reflexive modernization. It relapsed from an effort for reflexive modernization to (...) ecological modernization, by ultimately leaving the structural features of the sociotechnical regime intact. We show how this resulted from the biases and limitations implied by existing institutions, in which the project was unavoidably embedded. We introduce the idea of reflexive design, as “doing” reflexive modernization, which implies working on action and structure at the same time. A number of recommendations are given for reflexive design projects like this. (shrink)

In this contribution, I wish to explore the potential of health technology assessment and ethics for increasing our capacity to pre-empt the shortcomings and undesired consequences of modern health care while maintaining its benefits. Central is the presumption that in case of some health problems this cannot be done unless we explicitly reconsider some features of the modern health care system, especially those related to its strong reliance on scientific rationality and the strong role played by medical professionals.So as to (...) both maintain the benefits of advanced health care and ensure that it produces less reason for concern, we need to reconsider our approach to rationality—and maybe even the way in which we build our health care system around that rationality. That is, we need to introduce an element of reflexivity. Two types of circumstances are being explored in which such reflexivity may prove worthwhile: controversies on side effects, and persistent problems encountered in optimising health care. Drawing on brief discussions of typical cases, we explore the potential of reflexive HTA and its methodical prerequisites.We conclude that ethicists may contribute to reflexive HTA, if they combine a hermeneutic—and often also participative—methodology with a solid understanding of the relation between the health problem under scrutiny and more general critique of the health care system. Insights from the areas of science and technology studies, as well as from social philosophy may be critical items in their tool kit. (shrink)

A possible explanation for policy implementation failure is that the views of the policy’s target groups are insufficiently taken into account during policy development. It has been argued that involving these groups in an interactive process of policy development could improve this. We analysed a project in which several target populations participated in workshops aimed to optimise the utilisation of an expensive novel drug (interferon beta) for patients with Multiple Sclerosis. All participants seemed to agree on the appropriateness of establishing (...) a central registry of Multiple Sclerosis patients and developing guidelines. Nevertheless, these policy measures were not implemented. Possible explanations include (1) the subject no longer had high priority when the costs appeared lower than expected, (2) the organisers had paid insufficient attention to the perceived problems of parties involved, and (3) changes within the socio-political context. The workshops in which representatives of the policy’s target populations participated did not provide enough interactivity to prevent policy implementation failure. (shrink)