Regulating patient access to therapeutics in Denmark: A rhetorical analysis of welfare imaginaries in public controversy

Abstract

In this article, I argue that the social imaginaries that inform biomedical regulation circulate not only in technical spheres populated by experts but that they are equally articulated (and vehemently contested) in national public spheres in more popular forms of communication. I examine the relation between a national healthcare imaginary and the regulation of therapeutics through a public controversy about access to an innovative therapeutic indicated for spinalmuscular atrophy. The establishment of the DanishMedicinesCouncil, a new health technology assessment institution, and its decision to restrict access to an innovative therapeutic sparked controversy in 2017 involving political proponents, adversaries, and patients, among others. In a variety of ways, they rhetoricallymobilized or contested the Danish universalist welfare imaginary which contains promises and prospects of solidarity, security, and absence of market forces in universal healthcare, including access to therapeutics. I use a combination of media content analysis and rhetorical close reading methods to analyze how the imaginary was drawn upon in arguments for and against the new regulatory institution.