Democracy, technocracy, and the secret state of medicines control: expert and nonexpert perspectives

This article explores the social frameworks guiding expert and nonexpert perspectives on medicines safety in the U.K. Scientific experts from the Committee on the Safety of Medicines and the Medicines Commission were interviewed, and three nonexpertgroups, including patients and health professionals, were studied by the administration of questionnaires and focused group discussions. The research examined to what extent these groups subscribed to technocratic or democratic approaches to medicines regula tion and how this might be related to values toward technological risk. The results reveal that there is substantial divergence between expert and nonexpert perspectives on medicines regulation, and that this derives as much from value differences as from any informational deficits. However, there seems to be some scope for shared values between some experts and some nonexperts, especially as regards state secrecy. The article concludes by discussing how those values could be used to foster a new "social contract of expertise" in which scientists are more democratically accountable and patients take more responsibility in governing medical risks.