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The article focuses on the biased behavior shown by the social organizations in providing health care facilities in France. The lower class is often neglected while the upper class gets the privilege of the medical care facilities. The new technological and social innovations exclude the poorest category of population.

How can one assess the quality of life of older people – particularly those with Alzheimer's disease – from the point of view of their opportunities to do valued things in life? This paper is an attempt to answer this question using as a theoretical framework the capability approach. We use data collected on 8841 individuals above 60 living in France (the 2008 Disability and Health Household Survey) and propose a latent variable modelling framework to analyse their capabilities in two fundamental dimensions: freedom to perform self-care activities and freedom to participate in the life of the household . Our results show that living as a couple, having children, being mobile and having access to local shops, health facilities and public services enhance both capabilities. Age, household size and male gender (for one of the two capabilities) act as impediments while the number of impairments reduces both capabilities. We find that people with Alzheimer's disease have a lower level and a smaller range of capabilities (freedom) when compared to those without, even when the latter have several impairments. Hence they need a special attention in policy-making. [ABSTRACT FROM AUTHOR]

The proliferation of biomarkers has raised concerns regarding the possibility for clinical judgment to be improperly removed from clinician's jurisdiction and included in laboratory tests. To evaluate the ways in which the diffusion of biomarkers questions the autonomy of clinicians, we consider the case of chemotherapy prescription to women with early stage breast cancer and a good prognosis. Drawing on a qualitative study of clinicians working in a diversity of institutional contexts, we follow three biomarkers available to guide this routinely made decision. We show that, biomarkers able to reduce all the uncertainties associated with, what we analyse as an uncomfortable decision, are sought more than dreaded by clinicians. If such ideal tools are unavailable, the fact is well acknowledged by the profession. Rather than precluding their usage, the imperfection of existing biomarkers is controlled by the profession, through their integration as additional tools in the decision process. The fact that the biomarkers are recognized as imperfect biomedical entities reinforces the importance of local material, organizational and financial constraints over that of international science, technology and clinical data, in their diffusion. The regulation of the uncertainties associated with these imperfections is organized at the professional level. Through an important work, relying on guidelines and enforced in collective bodies, the series of heterogeneous bioclinical evidences available are articulated. Biomarkers tend to be subordinated to the clinic. While maintaining the professional autonomy, the process also strengthens the internal professional hierarchy. When the most expert clinicians manage to inhabit a space for clinical autonomy, the nonexpert are torn between stronger professional rules and patient preferences. In this alliance between biomarkers and experts, their clinical autonomy tends to be the price for the professional autonomy. • Biomarkers available to guide chemotherapy in early breast cancer are all imperfect. • Imperfections reinforce impact of local constraints and culturally situated practices. • Managed collectively, imperfections allow to put the clinic ahead of technology. • Alliance of biomarkers and expert clinicians stiffens internal professional hierarchy. [ABSTRACT FROM AUTHOR]

Involvement of patients in the ethical management of research protocols began by patients' associations involved in the fight against AIDS in France in the 1990s. It was the first step towards recognizing the major role of patients in research that concerns them. This article aims describing this emancipation and its consequences on the evolution of research by drawing on two experiences: 1) The one of the « Comité de patients pour la recherche clinique » founded in 1998 by the « Ligue nationale contre le cancer » and by the « Fédération nationale des centres de lutte contre le cancer »; 2) The one of the « Collège des relecteurs de l'Inserm » set up in 2007., (© 2023 médecine/sciences – Inserm.)

Fraud is only a part of misconduct in research. Very few French research Institutions have a scientific integrity office, and their prevention. The Institut national de la santé et de la recherche médicale (Inserm) has created a "Scientific Integrity delegation". Scientific Integrity is an international concern. Scientific Integrity is closely linked to organisation, management and evaluation of all research activities., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)