Professional disruption in health regulation: electronic cigarettes in the European Union

Abstract

Abstract:How do professions respond to fast-moving technological changes? Disruptive innovations overturn expectations about how markets function and develop, and they often raise moral, legal and scientific concerns among professionals. Sudden technological changes can result in a state of professional disruption, in which technological change challenges the institutional arrangements of a profession. This article distinguishes between fast and slow processes of professional change, focusing on the role of technology as one cause of fast changes to a profession. Professionals and non-professionals engage in framing contests that draw on cognitive, normative and relational keys to signal their expectations. It is in these framing contests that professionals run the risk of disruption. Drawing on interview data with key policy actors, I investigate electronic cigarettes regulation in the European Union and its recent revision to the Tobacco Products Directive. Medical and public health professionals that control tobacco issues were challenged by a coalition of e-cigarette industry representatives, e-cigarette users, and liberal politicians. The challengers drew on the contending norm of harm reduction in tobacco control, which successfully challenged the centrality of the abstinence norm in the institutional arrangements of the medical and public health professions and their organizational field. By discussing the parallels to other related cases in health regulation, I draw out the implications of the study for researchers and policymakers.

War and organizational disruption in professional service firms

“…One of the most insidious of these is international military conflict. Consistent with Hasselbalch's (2016) exhortation to open the black box on how individual professionals comprehend and navigate through disruptive events, the current paper has sought to explore the responses of a distinctive professional community to a disturbance that threatened the stability and survival of practices. This crisis arose during what has been described as the first hyperstatic disaster of the modern era, the First World War.…”

“…Disruptive events may engender change of varying degrees -sometimes major, other times minor. The pace of professional change may be fast or slow (Hasselbalch, 2016). But it is also suggested that the fundamental structures and ideologies of the past may resurface in the wake of disturbance and endure beyond it.…”

“…Disruption and crisis have emerged as important themes in the pages of the Journal of Professions and Organization (Hasselbalch, 2016;Leicht, 2016;Spence, Voulgaris and Maclean, 2017). Journal content attests to the advancing interest in professions' experiences of and responses to disturbance.…”

“…Journal content attests to the advancing interest in professions' experiences of and responses to disturbance. Studies have shown how states of 'professional disruption' may be incited by rapid technological change (Hasselbalch, 2016) and how market fundamentalism, cultural fragmentation and post-modern scepticism have placed professions in a state of crisis (Leicht, 2016). Further, political orientation and the commercial ideology have been revealed as contributors to the crisis that currently afflicts the professions (Spence et al, 2017).…”

“…Consistent with this call, the paper provides insights to the relationships between practitioner firms and qualifying associations, and also illuminates the interactions of these institutions with agencies of the state during a period of disturbance. Hasselbalch (2016) has demonstrated the insights to be gained from micro-level analyses of how individuals in professional firms comprehend and respond to disruptive events. He also revealed the potency of 'opening up the black box of the single, disruptive event and focussing analytical attention on the processes that occur as it unfolds'.…”