Staging and Weighting Evidence in Biomedicine

Abstract

This paper seeks to make a contribution to the discussion on what clinical work consists of in biomedicine. It draws on the comparison between two clinical practices: (1) cancer genetics of breast/ovarian and colon cancers; and (2) psychiatric genetics of autism and its related syndromes. We argue that the clinic does not reflect genetic reductionism, nor does it entail a straightforward return to the previous clinical tradition. We show that the clinic is affected by three changes in the practices that we studied. The first change concerns clinical settings: clinical work is now performed by ‘bioclinical collectives’, gathering researchers and clinicians from various disciplines and activities, and conjointly searching biology and pathology. The second change concerns the content of clinical work that we propose to call ‘clinic of mutations’. This clinic involves the intense work of collecting and comparing multiple and heterogeneous data to document the biological nature and the clinical relevance of mutations, whose status is ambiguous and whose effects are uncertain. The third change concerns the dynamics of clinical work, which is now overlapping with research. As a consequence, the elaboration of a judgment and a medical decision is no longer a matter of simply making a diagnosis or prognosis. Rather it consists in accounting for nosographic domains and descriptive and interpretive models of diseases, into which mutations may plausibly play a role. We conclude with a discussion of the form of objectivity underlying clinical work in biomedicine. Our contention is that in the current post-genomic era, thinking of genetic markers as objective proofs of a disease or a risk of disease is definitely inappropriate. Rather, the clinic has to constantly produce the meaning and relevance of mutations and biomedical entities that tend to proliferate and regularly invade the clinical settings.

La estabilización del diagnóstico psiquiátrico: los psicofármacos como objetos frontera

“…These studies agree that the reconfiguration of clinical judgement in biomedicine has involved a shift in locus from clinical to bioclinical collectives (Bourret, 2005), maintaining slight differences in descriptions of this process. The majority of these works have been carried out in the field of oncology, where research is highly active (Rabeharisoa & Bourret, 2009). In the field of psychiatry, however, less attention has been paid to this development.…”

“…On the contrary, as part of the normal routines, the psychiatrists deal with the ambiguity. In the current biomedical context and perhaps due to the lower degree of development and stabilization of scientific knowledge within psychiatry (Rabeharisoa & Bourret, 2009), a surprising situation has been observed in the following conversation in a medical ward, Extract Nº 2:…”

Locating genetic disease: the impact of clinical nosology on biomedical conceptions of the human genome (1966–1990)

“…Biomedicine instead involves intellectually and institutionally collaborative spaces or "platforms," which are "benches upon which conventions concerning the biological or normal are connected with conventions concerning the medical or pathological" (Keating and Cambrosio 2000, p. 386). Rabeharisoa and Bourret (2009) have described a similar combination of practices and specialties in their discussion of "bioclinical collectives." Still other scholars have expressed doubt about the transformative nature of biomedicine.…”

Reframing translational research as transactional research:

“…Crabu offers a thorough meta-analysis of sociological research examining translational medicine and finds that empirical work has mainly focussed on laboratories and crossovers between the laboratory and the clinic (Crabu, 2018). The paper thus also adds to empirical hospital-based studies of translational research, since few STS studies take hospital-based clinician-scientists as the starting point for examining translational medicine (Rabeharisoa and Bourret, 2009).…”