Ends, means, beginnings: environmental technocracy, ecological deliberation or embodied disagreement

Technocratic attitudes suggest that decisions about environmental policy should be led by scientific experts. Such decisions, it is expected, will be more rational than any arrived at by a democratic mediation between the narrow, short-term interests and uninformed preferences of the general public. Within green political theory, deliberative democracy has emerged as the dominant repost to technocracy, offering an account of how democratic polities can deal with complex scientific and technological decisions through the emergence of communicative rationality. This article argues that neither appeals to expert knowledge, nor communicative rationality, are likely to deliver the optimal green outcomes that proponents suggest, but rather will cover up the inevitable disagreements over environmental policy making. Instead the article suggests that more ecologically-sensitive and democratic decision making about complex scientific and technological issues can emerge if we acknowledge the differently embodied perspectives of decision-makers – from scientists to citizens. This prioritises democratic means over green ends, yet incorporates the environment at the beginning of the decision-making process. The article aims to sketch out the theoretical and practical implications of such an embodied turn for responding to the anti-democratic tendencies of environmental technocracy.

Telaprevir or boceprevir based therapy for chronic hepatitis C infection: Development of resistance-associated variants in treatment failure

The use of triple-therapy, pegylated-interferon, ribavirin and either of the first generation hepatitis C virus (HCV) protease inhibitors telaprevir or boceprevir, is the new standard of care for treating genotype 1 chronic HCV. Clinical trials have shown response rates of around 70–80%, but there is limited data from the use of this combination outside this setting. Through an expanded access programme, we treated 59 patients, treatment naïve and experienced, with triple therapy. Baseline factors predicting treatment response or failure during triple therapy phase were identified in 58 patients. Thirty seven (63.8%) of 58 patients had undetectable HCV RNA 12 weeks after the end of treatment. Genotype 1a (p = 0.053), null-response to previous treatment (p = 0.034), the rate of viral load decline after 12 weeks of previous interferon-based treatment (p = 0.033) were all associated with triple-therapy failure. The most common cause of on-treatment failure for telaprevir-based regimens was the development of resistance-associated variants (RAVs) at amino acids 36 and/or 155 of HCV protease (p = 0.027) whereas in boceprevir-based regimens mutations at amino acid 54 were significant (p = 0.015). SVR12 rates approaching 64% were achieved using triple therapy outside the clinical trial setting, in a patient cohort that included cirrhotics.