Periodic Reporting for period 4 - MISFIRES (Misfires and Market Innovation: Toward a Collaborative Turn in Organising Markets)
Reporting period: 2023-02-01 to 2024-07-31
MISFIRES studied how markets are innovated through activist contestations. MISFIRES’ aim was to establish what makes markets ‘better’ from the perspective of those let down or marginalised by them, and what actions these actors can take to open up the markets in question to their concerns. The project asked how actors can engage with a market’s failures to challenge its organisation and make it more collaborative, more open to civic values and to social or political concerns. It took healthcare markets as prototypical examples of ‘concerned markets’, characterised by diverse interests of multiple actors, significant social and political stakes, and a long tradition of collective action. To understand market-based activism in these markets, I developed new conceptual frameworks that explain how actors try to reconfigure or innovate them from the inside to make these markets ‘better’ and new empirical insights that map how collaborative action in such markets translates into market change. These insights are vital to understand how researchers and policy makers may support these processes.
Conceptually, I engaged with science and technology studies, pragmatic sociology and critical market studies to shift thinking around market organisation and innovation from failure and design to collaboration and experimentation. Healthcare markets offer exemplary sites for this investigation for a number of reasons. The healthcare domain has witnessed strong and long-standing patient movements and activism. Notions of justice and public good in this area are of central societal importance. Severe criticism has been made of the effects of the global Intellectual Property (IP) regime in this area, raising the study of healthcare markets to an economic and political significance beyond any single case. Research has also pointed to the difficulties of market-based experiments such as Medicine Patent Pools to engender systemic changes in medical markets. This raises vital questions of how 'outside' activism may complement 'insider' activism to help create structural market innovation.
The project leveraged a mixed methodological toolkit with ethnographic and participatory methods of inquiry, including digital methods of collaboration and research, to explore how a market’s failures can lead us to markets that are more attentive to and accommodating of the concerns they create. Empirical work was organized through a multiple case study approach, with three exemplary contested markets in healthcare (HIV prophylaxis, Hepatitis C, and the use of DNA data) and three emergent cases (Type 1 Diabetes hacking; Covid19; and Long Covid-ME/CFS) to investigate the activities concerned actors undertake and the repertoires of action they deploy to re-organise these markets.
Conceptually, I engaged with science and technology studies, pragmatic sociology and critical market studies to shift thinking around market organisation and innovation from failure and design to collaboration and experimentation. Healthcare markets offer exemplary sites for this investigation for a number of reasons. The healthcare domain has witnessed strong and long-standing patient movements and activism. Notions of justice and public good in this area are of central societal importance. Severe criticism has been made of the effects of the global Intellectual Property (IP) regime in this area, raising the study of healthcare markets to an economic and political significance beyond any single case. Research has also pointed to the difficulties of market-based experiments such as Medicine Patent Pools to engender systemic changes in medical markets. This raises vital questions of how 'outside' activism may complement 'insider' activism to help create structural market innovation.
The project leveraged a mixed methodological toolkit with ethnographic and participatory methods of inquiry, including digital methods of collaboration and research, to explore how a market’s failures can lead us to markets that are more attentive to and accommodating of the concerns they create. Empirical work was organized through a multiple case study approach, with three exemplary contested markets in healthcare (HIV prophylaxis, Hepatitis C, and the use of DNA data) and three emergent cases (Type 1 Diabetes hacking; Covid19; and Long Covid-ME/CFS) to investigate the activities concerned actors undertake and the repertoires of action they deploy to re-organise these markets.
This project has led to significant academic and policy outputs. Overall, the lead Principal Investigator, Prof Susi Geiger, and project members published 37 journal publications in highly ranked international journals (Impact Factors ranging from 2.3 to 10.8) associated with their work on this project. Prof Susi Geiger also published two edited volumes and one monograph: "Healthcare Activism: Markets, Morals and the Collective Good" (Oxford University Press, 2021); "Market Studies: Mapping, Theorizing and Impacting Market Action" (Cambridge University Press, Octobeer 2024) and "Peak Pharma: Toward a new pharmaceutical political economy" (Oxford University Press, April 2025). Beyond these academic outputs, the project has led to 51 conference papers, 7 conference tracks, 9 project workshops and events, 2 public exhibitions, 18 project blogs and several public policy interventions, including four papers on the website publicpolicy.ie. As the project included a participatory design, Prof Susi Geiger has also deeply engaged with the advocacy groups Access to Medicines Ireland, Public Pharma for Europe and Digital Rights Ireland. Overall, these outputs construct a detailed and empirically grounded framework of activism in medical markets. They clearly demonstrate how researchers can engage with activists to challenge many of the received beliefs in pharmaceutical markets.
MISFIRES has opened up the field to a sociology of market innovation. We have shown through our cases how civil society finds ways to contest the state of markets in seemingly highly stable markets. MISFIRES' focus on contestations that relate to these exchange practices and its tracing of their effects expand the state of the art in social movement literature, organization studies and critical market studies. At its conceptual core and through its six different cases, MISFIRES explored the notion of collective good in relation to an area of fundamental societal importance: healthcare. Drawing on interdisciplinary insights, MISFIRES has interrogated how healthcare markets draw on, distribute, conjecture and diffract different values and conceptions of the collective good and how these practices are challenged and reflected by policymakers, industry stakeholders and activists. We particularly highlight the success of ‘inside/outside’ strategies such as those used in our case of a Type 1 Diabetes community that ignited significant breakthrough in regulation and innovation of diabetes medical devices. Our work around transparency of pharmaceutical markets has also led to considerable scientific breakthrough: this work shows how policymakers can ‘bake in’ structural power into the manner through which they put in place mechanisms to realise seemingly public goods related notions such as transparency. These structural mechanisms are difficult to undo unless they are tackled through what we have previously (Geiger and Gross 2018) named as ‘redevising’: redoing the very mechanisms through which such notions are instrumented.
From an empirical perspective, one fundamental strand of this research was the use of participatory methods of inquiry to include patient advocacy groups and other affected publics as key stakeholders in this project. MISFIRES conducted research by and with affected publics rather than ‘on’ them, and it explored new terrain in how innovative research methods can be used in the development of ‘better’ healthcare markets, for instance through an art-based project with people living with Long Covid and ME/CFS. The aim of this participatory inquiry was to produce, in collaboration with market activists and concerned publics, a collective analysis of the economic, social or moral problems posed by the current market organisation, and subsequently propose and test ways in which these markets could be opened up to alternative configurations. Questions asked include (how) could collaborative tools be used in advancing public reflections on markets? How can researchers help concerned publics move from reflecting to redevising the market, from deliberation to action? What is the role of the participant researcher, academic activist or policy maker in bringing these forums to life or in helping concerned publics get their concerns included in existing forums? Across its substantial body of outputs, the project has provided many significant answers to these questions.
As a direct result of the project, the Lead PI Prof Susi Geiger was appointed as an Expert Member to the World Health Organization Technical Advisory Group on Pharmaceutical Pricing Policies.
From an empirical perspective, one fundamental strand of this research was the use of participatory methods of inquiry to include patient advocacy groups and other affected publics as key stakeholders in this project. MISFIRES conducted research by and with affected publics rather than ‘on’ them, and it explored new terrain in how innovative research methods can be used in the development of ‘better’ healthcare markets, for instance through an art-based project with people living with Long Covid and ME/CFS. The aim of this participatory inquiry was to produce, in collaboration with market activists and concerned publics, a collective analysis of the economic, social or moral problems posed by the current market organisation, and subsequently propose and test ways in which these markets could be opened up to alternative configurations. Questions asked include (how) could collaborative tools be used in advancing public reflections on markets? How can researchers help concerned publics move from reflecting to redevising the market, from deliberation to action? What is the role of the participant researcher, academic activist or policy maker in bringing these forums to life or in helping concerned publics get their concerns included in existing forums? Across its substantial body of outputs, the project has provided many significant answers to these questions.
As a direct result of the project, the Lead PI Prof Susi Geiger was appointed as an Expert Member to the World Health Organization Technical Advisory Group on Pharmaceutical Pricing Policies.