Therapy's Shadow: A Short History of the Study of Resistance to Cancer Chemotherapy

This article traces the history of research on resistance to drug therapy in oncology using scientometric techniques and qualitative analysis. Using co-citation analysis, we generate maps to visualize subdomains in resistance research in two time periods, 1975–1990 and 1995–2010. These maps reveal two historical trends in resistance research: first, a shift in focus from generic mechanisms of resistance to chemotherapy to a focus on resistance to targeted therapies and molecular mechanisms of oncogenesis; and second, a movement away from an almost exclusive reliance on animal and cell models and toward the generation of knowledge about resistance through clinical trial work. A close reading of highly cited articles within each subdomain cluster reveals specific points of transition from one regime to the other, in particular the failure of several promising theories of resistance to be translated into clinical insights and the emergence of interest in resistance to a new generation of targeted agents such as imatinib and trastuzumab. We argue that the study of resistance in the oncology field has thus become more integrated with research into cancer therapy – rather than constituting it as a separate domain of study, as it has done in the past, contemporary research treats resistance as the flip side to treatment, as therapy’s shadow.

Neural circuits underlying adaptation and learning in the perception of auditory space

Sound localization mechanisms are particularly plastic during development, when the monaural and binaural acoustic cues that form the basis for spatial hearing change in value as the body grows. Recent studies have shown that the mature brain retains a surprising capacity to relearn to localize sound in the presence of substantially altered auditory spatial cues. In addition to the long-lasting changes that result from learning, behavioral and electrophysiological studies have demonstrated that auditory spatial processing can undergo rapid adjustments in response to changes in the statistics of recent stimulation, which help to maintain sensitivity over the range where most stimulus values occur. Through a combination of recording studies and methods for selectively manipulating the activity of specific neuronal populations, progress is now being made in identifying the cortical and subcortical circuits in the brain that are responsible for the dynamic coding of auditory spatial information.

Cancer clinical trials in the era of genomic signatures: biomedical innovation, clinical utility, and regulatory-scientific hybrids

The paper examines two large-scale, North American and European clinical trials designed to validate two commercially available genomic tumor signatures that predict a patient's risk of breast cancer recurrence and response to chemotherapy. The paper builds on empirical evidence from the two trials to explore the emergence of diverse regulatory-scientific hybrids; that is, the paper discusses configurations of genomic practice and bioclinical work that depend on linkages between technical, commercial, patient, clinical, and legal interests and institutions. The development of the genomic signatures for each trial--Oncotype DX and MammaPrint--has followed quite different routes. Oncotype began as a commercial platform: the company that produced it did not discover a signature but rather constructed it by asking users at every step what clinical question they wanted the signature to answer and what data would be credible in that regard. The test has been designed to minimally disrupt existing clinical workflows. MammaPrint, on the other hand, began as a breast cancer signature: the researchers who discovered it, at the Netherlands Cancer Institute (NKI), established a company to commercialize it as a test after the fact. MammaPrint requires a change in pathologists' routines. Thus, while these two trials signify a new departure for clinical cancer trials on a number of levels--they both incorporate new models of interaction between biotech companies and public research, and they both aim to establish the clinical relevance of genomic markers--they also embody different socio-technical scripts: one attempts to accommodate established routines, while the other openly challenges prevailing evidential hierarchies and existing biomedical configurations.

Adaptation to stimulus statistics in the perception and neural representation of auditory space

Sensory systems are known to adapt their coding strategies to the statistics of their environment, but little is still known about the perceptual implications of such adjustments. We investigated how auditory spatial processing adapts to stimulus statistics by presenting human listeners and anesthetized ferrets with noise sequences in which interaural level differences (ILD) rapidly fluctuated according to a Gaussian distribution. The mean of the distribution biased the perceived laterality of a subsequent stimulus, whereas the distribution's variance changed the listeners' spatial sensitivity. The responses of neurons in the inferior colliculus changed in line with these perceptual phenomena. Their ILD preference adjusted to match the stimulus distribution mean, resulting in large shifts in rate-ILD functions, while their gain adapted to the stimulus variance, producing pronounced changes in neural sensitivity. Our findings suggest that processing of auditory space is geared toward emphasizing relative spatial differences rather than the accurate representation of absolute position.

Chronic detachable headphones for acoustic stimulation in freely moving animals

A growing number of studies of auditory processing are being carried out in awake, behaving animals, creating a need for precisely controlled sound delivery without restricting head movements. We have designed a system for closed-field stimulus presentation in freely moving ferrets, which comprises lightweight, adjustable headphones that can be consistently positioned over the ears via a small, skull-mounted implant. The invasiveness of the implant was minimized by simplifying its construction and using dental adhesive only for attaching it to the skull, thereby reducing the surgery required and avoiding the use of screws or other anchoring devices. Attaching the headphones to a chronic implant also reduced the amount of contact they had with the head and ears, increasing the willingness of the animals to wear them. We validated sound stimulation via the headphones in ferrets trained previously in a free-field task to localize stimuli presented from one of two loudspeakers. Noise bursts were delivered binaurally over the headphones and interaural level differences (ILDs) were introduced to allow the sound to be lateralized. Animals rapidly transferred from the free-field task to indicate the perceived location of the stimulus presented over headphones. They showed near perfect lateralization with a 5 dB ILD, matching the scores achieved in the free-field task. As expected, the ferrets' performance declined when the ILD was reduced in value. This closed-field system can easily be adapted for use in other species, and provides a reliable means of presenting closed-field stimuli whilst monitoring behavioral responses in freely moving animals.

Who's minding the data? Data Monitoring Committees in clinical cancer trials

Modern biomedicine is based on a number of novel institutions and practices that, in order to function, require some degree of formal and informal regulation. This paper contributes to the ongoing investigation of these processes, and the forms of objectivity they generate, by examining the emergence, development and deployment of Data Monitoring Committees in the field of clinical trials. The idea of a DMC had originally been raised in the clinical trial methodology literature in the 1970s so as to solve the problem of the management of interim trial data. Many leading clinical trial statisticians proposed that interim data and analyses be restricted to members of a DMC. Since the late 1980s, DMCs have evolved considerably in a constant search for ethical neutrality and objectivity through the use of sophisticated statistical techniques and novel organisational strategies. They have also been beset by a fundamental tension as to who or what should count as objective in such an undertaking. The paper examines the evolution of this institution in terms of the techniques brought to bear on the issues that they are expected to solve, the organisational forms through which DMCs have evolved and the ideals of objectivity that these forms embody.

Phages, antibodies and de-monstration

Using examples from the field of molecular genetics and immunology, this paper examines the argumentative strategy underlying the use of electron micrographs as decisive evidence for previously uncertain or disputed claims. Scientists often resort to visual imagery in order to demonstrate the factual status of their claims and thus to compel assent from their peers, therefore bypassing other forms of argumentation such as propositional reasoning. The particular form of demonstration discussed in this article resorts to the use of photography rather than drawings and diagrams. While the mechanical objectivity of micrographs certainly adds to their evidential strength, the pictures we examine derive part of their power from their arrangement in a sequence that mimics experimental operations. The visual argument tracks the textual report of the steps in a biochemical or molecular genetic experiment, with which it becomes intimately associated. We conclude that much of the evidential strength conveyed by the articles we analyze is to be sought less in the extrinsic attributes of the instrumentation they mobilized than in the specific material and argumentative practices enacted by those particular uses of the instrument.

The emergence of clinical practice guidelines

Clinical practice guidelines are now ubiquitous. This article describes the emergence of such guidelines in a way that differs from the two dominant explanations, one focusing on administrative cost-cutting and the other on the need to protect collective professional autonomy. Instead, this article argues that the spread of guidelines represents a new regulation of medical care resulting from a confluence of circumstances that mobilized many different groups. Although the regulation of quality has traditionally been based on the standardization of professional credentials, since the 1960s it has intensified and been supplemented by efforts to standardize the use of medical procedures. This shift is related to the spread of standardization within medicine and especially in research, public health, and large bureaucratic health care organizations.

A case of torted parafimbrial cyst on MRI: case report and review of the literature

Para-ovarian cysts (POCs) are an occasional finding at surgery, although they are rarely appreciated on imaging studies. Accurate diagnosis depends upon the demonstration of a para-ovarian location. We present the MR appearances of a torted POC in a fimbrial location, resembling a dermoid cyst.

Cancer clinical trials: the emergence and development of a new style of practice

Clinical trials are the principal vector for the development of chemotherapy, and they have become such a pervasive element of clinical cancer research that modern oncologists tend to take them for granted. Yet the system of cancer clinical trials amounts to a relatively recent (post-World War II) innovation. Its development has proceeded through ad hoc adjustments, and has produced a self-vindicating, yet open-ended, style of practice. This paper examines the historical development and articulation of the components of this new style of practice (protocols, oncologists, statistics, patients, and diseases), and of the new kind of objectivity they engender, by drawing on selected examples from American and European cancer clinical trial systems.

Mapping the emergence and development of translational cancer research

Cancer research is one of the principal targets of translational research, yet the nature of the relationships between different forms of cancer research remains controversial. The paper examines publications in the cancer field during the 1980-2000 period. A network analysis software program was used to map evolving patterns of inter-citations between cancer publications, their different research levels and the transformation of their relational content. Both inter-citation and content maps provide striking evidence of the consolidation in the 1990s of a translational interface that was practically non existent a few decades before. In 1980, research was polarized according to the allegiance to either a clinical or a laboratory style. This same duality obtains in the year 2000, albeit with the additional presence of a third, biomedical player whose activities are similarly structured by a common orientation, rather than by an exclusive commitment to a specific sub-domain.

Regulatory objectivity and the generation and management of evidence in medicine

The evolution of Western medicine since World War II has resulted in the emergence of new practices based on the direct interaction of biology and medicine. The post-war realignment of biology and medicine has been accompanied by the emergence of a new type of objectivity, regulatory objectivity, that is based on the systematic recourse to the collective production of evidence. Unlike forms of objectivity that emerged in earlier eras, regulatory objectivity consistently results in the production of conventions, sometimes tacit and unintentional but most often arrived at through concerted programs of action. These actions incorporate unprecedented levels of reflexivity, in the sense that biomedical practitioners in their debates and discussions take into account the conventional dimension of their endeavors. The conventions produced by regulatory objectivity create the conditions for a clinical objectivity that relies on the existence of entities and protocols produced and maintained far outside the intimate encounter between doctor and patient. By establishing endogenous forms of regulation, regulatory objectivity operates on a different plane and in a different mode from those suggested by analysts who treat all regulation as a form of rationalization imposed upon medicine from without.

[What is biomedicine? A socio-historical outline]

The article examines the debates surrounding the emergence of the term biomedicine, with a particular focus on the relation between the pathological and the normal. The authors reject simplistic definitions of biomedicine as a one-way street leading to the application of medical knowledge to medicine, or even as a two-way street characterized by iterative exchanges between the clinic and the laboratory. Rather, the authors introduce the notion of a biomedical platform as the site where the clinic and the laboratory intermingle and are realigned in connection with the ongoing process of medical innovation and the increasing automation of molecular procedures. The examples used in the article are drawn mainly from the field of onco-hematology.

Does biomedicine entail the successful reduction of pathology to biology?

The idea of reducing pathology to biology has an extensive history, and the initial forms of the enterprise were unsuccessful. This article discusses the philosophical literature surrounding the notion of reduction in the sciences in general and of biology in particular; reviews several 19th-century programs that promoted the reduction of medicine to other biological disciplines; and examines the post-war origins of the notion of biomedicine. It shows how biology and medicine tend to interact in the constitution of new biomedical knowledge and how the notion of a pathological process resulting in a lesion remains central to the understanding of disease. The article proposes that while strict reduction has yet to be realized, one can speak of a continuing and successful realignment of biology and pathology since the Second World War.

From screening to clinical research: the cure of leukemia and the early development of the cooperative oncology groups, 1955-1966

Recent work in the history and sociology of biomedicine has emphasized the novelty of the biomedical enterprise as a distinctive institutional, material, and epistemological configuration. Since World War II, biology and medicine have become such tightly intertwined research enterprises that those working in biomedicine cannot predict whether a particular research project, clinical investigation, or even clinical intervention will result in biological or medical facts. In this paper, we examine part of the process of the emergence of biomedicine by focusing on the development of clinical cancer trials in the United States in the years 1955-66, a period during which the clinical trials program run by the National Cancer Institute became autonomous from the Institute's screening program for anticancer compounds. We examine in particular the work carried out by the cooperative groups and the Acute Leukemia Task Force to which they belonged, analyzing the evolution of the relations between screening, chemotherapy, clinical trials, and clinical research.

Oral antibodies to human papillomavirus type 16 in women with cervical neoplasia

This study investigated the relationship between human papillomavirus type 16 (HPV-16) antibodies detected in oral fluid from women with cervical neoplasia, their HPV-16 antibody seroprevalence, and their cervical HPV-16 DNA presence. Cervical HPV-16 DNA was detected by polymerase chain reaction in 43.2% (35/81) of these women. The prevalence of IgG and IgA antibodies to HPV-16 virus-like particles (VLP-16) in oral fluid and was investigated by enzyme-linked immunosorbent assay. Anti-VLP-16 IgA antibodies were detected in oral fluid from 54.3% (44/81) of women with cervical neoplasia, compared with 8% (3/36) in controls (P = 0.000002). Anti-VLP-16 IgG was detected in oral fluid from 43.2.9% (25/72) and 13.3% (4/30; P = 0.029), respectively. Women who were HPV-16 DNA positive at their cervical lesion, displayed an oral fluid anti-VLP-16 IgA prevalence of 60.7% (17/28) and HPV-16 DNA negative women an oral fluid anti-VLP-16 IgA prevalence of 50% (20/40; P = 0.38). Oral fluid anti-VLP-16 IgG prevalence in HPV-16 DNA positive women was 28.6% (8/28) compared with 40% (16/40) in oral fluid from HPV-16 DNA negative women (P = 0.3). Amongst HPV-16 DNA positive women, the anti-VLP-16 IgG seroprevalence was 75% (21/28) and IgA seroprevalence 35.7% (10/28) and for the HPV-16 DNA negative women these values were 60% (24/40) and 32.5% (13/40), respectively. Oral IgA antibody testing proved no more sensitive than serum antibody detection for the determination of HPV infection but could be useful as a non-invasive screening method for women with cervical neoplasia and for estimating the mucosal antibody response to HPV vaccines.

Tricuspid atresia--profile and outcome

Tricuspid atresia (TA) is the third most common cyanotic congenital cardiac lesion, with a mortality rate of 90% before the age of 10 years. Surgical intervention has reduced the mortality, but with unfavourable anatomy the mortality remains high. The aim of this study was to look at the profile of a cohort of children with TA and to evaluate treatment modalities and outcome. Twenty-seven children were included in this retrospective descriptive study. Twenty-three were referred with central cyanosis and 25% with cardiac failure. All patients had a left superior QRS axis on electrocardiogram (ECG). Eleven patients died, 8 before surgical intervention and 3 postoperatively. Outcome was mainly influenced by the anatomy of the pulmonary arteries especially when the pulmonary arteries were extremely hypoplastic. Patients with increased pulmonary blood flow did better than those with decreased pulmonary blood flow. There was a statistically significant difference in survival between the surgical and non-surgical groups. Few of our patients qualified for the Fontan procedure mainly because of increased pulmonary pressures in the high pulmonary blood flow group and severe hypoplastic pulmonary arteries in the low pulmonary blood flow group. Early referral is essential for palliation so that more definitive surgery can be done to achieve better results.

Language deficits in dyslexic children: speech perception, phonology, and morphology

We investigated the relationship between dyslexia and three aspects of language: speech perception, phonology, and morphology. Reading and language tasks were administered to dyslexics aged 8-9 years and to two normal reader groups (age-matched and reading-level matched). Three dyslexic groups were identified: phonological dyslexics (PD), developmentally language impaired (LI), and globally delayed (delay-type dyslexics). The LI and PD groups exhibited similar patterns of reading impairment, attributed to low phonological skills. However, only the LI group showed clear speech perception deficits, suggesting that such deficits affect only a subset of dyslexics. Results also indicated phonological impairments in children whose speech perception was normal. Both the LI and the PD groups showed inflectional morphology difficulties, with the impairment being more severe in the LI group. The delay group's reading and language skills closely matched those of younger normal readers, suggesting these children had a general delay in reading and language skills, rather than a specific phonological impairment. The results are discussed in terms of models of word recognition and dyslexia.