1
|
Making epistemic goods compatible: knowledge-making practices in a lifestyle intervention RCT on mindfulness and compassion meditation. BIOSOCIETIES 2022. [DOI: 10.1057/s41292-022-00272-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
2
|
Schultz É, Ward JK, Atlani-Duault L, Holmes SM, Mancini J. French Public Familiarity and Attitudes toward Clinical Research during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052611. [PMID: 33807787 PMCID: PMC7967331 DOI: 10.3390/ijerph18052611] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/02/2021] [Accepted: 03/02/2021] [Indexed: 01/18/2023]
Abstract
The COVID-19 pandemic put clinical research in the media spotlight globally. This article proposes a first measure of familiarity with and attitude toward clinical research in France. Drawing from the “Health Literacy Survey 2019” (HLS19) conducted online between 27 May and 5 June 2020 on a sample of the French adult population (N = 1003), we show that a significant proportion of the French population claimed some familiarity with clinical trials (64.8%) and had positive attitudes (72%) toward them. One of the important findings of this study is that positive attitudes toward clinical research exist side by side with a strong distancing from the pharmaceutical industry. While respondents acknowledged that the pharmaceutical industry plays an important role in clinical research (68.3%), only one-quarter indicated that they trust the industry (25.7%). Positive attitudes toward clinical trials were associated with familiarity with clinical trials (Odds Ratio, OR 2.97 [1.90–4.63]), financial difficulties (OR 0.63 [0.46–0.85]), as well as mistrust of doctors (0.48 [0.27–0.85]) and of scientists (OR 0.62 [0.38–0.99]). Although the French media provided a great deal of information on how clinical research works during the first months of the pandemic, there remains profound mistrust of the pharmaceutical industry in France. This suspicion can undermine crisis management, especially in the areas of vaccine development and preparation for future pandemics.
Collapse
Affiliation(s)
- Émilien Schultz
- CEPED (UMR 196), Université de Paris, IRD, 75006 Paris, France;
- SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, CANBIOS Team (Équipe Labellisée LIGUE 2019), Aix-Marseille University, INSERM, IRD, 13009 Marseille, France; (S.M.H.); (J.M.)
- Correspondence:
| | - Jeremy K. Ward
- CERMES3, INSERM, CNRS, EHESS, Université de Paris, 94801 Villejuif, France;
- VITROME, Aix-Marseille University, IRD, AP-HM, SSA, 13005 Marseille, France
| | - Laëtitia Atlani-Duault
- CEPED (UMR 196), Université de Paris, IRD, 75006 Paris, France;
- Institut COVID-19 Add Memoriam, University of Paris, 75006 Paris, France
- WHO Collaborative Center for Research on Health and Humanitarian Policies and Practices, IRD, Université de Paris, 75006 Paris, France
| | - Seth M. Holmes
- SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, CANBIOS Team (Équipe Labellisée LIGUE 2019), Aix-Marseille University, INSERM, IRD, 13009 Marseille, France; (S.M.H.); (J.M.)
- Society and Environment, Medical Anthropology, and Public Health, University of Berkeley, Berkeley, CA 94720, USA
- Mediterranean Institute for Advanced Study IMéRA, Institut Paoli Calmettes, Aix-Marseille University, 13004 Marseille, France
| | - Julien Mancini
- SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, CANBIOS Team (Équipe Labellisée LIGUE 2019), Aix-Marseille University, INSERM, IRD, 13009 Marseille, France; (S.M.H.); (J.M.)
- BioSTIC, APHM, Timone, 13005 Marseille, France
| |
Collapse
|
3
|
Hart RI, Boyle D, Cameron DA, Cowie FJ, Hayward L, Heaney NB, Jesudason AB, Lawton J. Strategies for improving access to clinical trials by teenagers and young adults with cancer: A qualitative study of health professionals' views. Eur J Cancer Care (Engl) 2021; 30:e13408. [PMID: 33474755 DOI: 10.1111/ecc.13408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/01/2020] [Accepted: 12/23/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Few teenagers and young adults (TYA) with cancer participate in clinical trials. Lack of opportunity has been identified as a major barrier. We canvassed health professionals' views on how TYA's access to trials might be improved. METHODS We interviewed 35 professionals with responsibility for delivering or facilitating cancer care and/or clinical trials. We analysed data using a qualitative descriptive approach. RESULTS Interviewees viewed improving TYA's access to trials as challenging, but possible. They reframed the problem as one of rare disease and surmised that modifying the organisation, administration and resourcing of research (and care) might expand opportunities for both TYA and other patients with low volume conditions. Proposals coalesced around four themes: consolidating the pool of patients; streamlining bureaucratic requirements; investing in the research workforce; and promoting pragmatism in trial design. CONCLUSION Accounts suggest there is scope to improve access to trials by TYA with cancer and other patients with rare diseases. Though re-configuring care, research and resource frameworks would present substantial challenges, doing nothing would also have costs. Change will require the support of a range of stakeholders, and agreement as to the best way forward. Further work, such as priority setting exercises, may be necessary to reach a consensus.
Collapse
Affiliation(s)
- Ruth I Hart
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Dorothy Boyle
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - David A Cameron
- NHS Research Scotland Cancer Lead and Cancer Research UK Edinburgh Centre, MRC Institute of Genetics & Molecular Medicine, Western General Hospital, University of Edinburgh, Edinburgh, UK
| | | | - Larry Hayward
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | | | - Angela B Jesudason
- Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Julia Lawton
- Usher Institute, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
4
|
Razumenko F. The Beginnings of the Canadian Cooperative Clinical Cancer Trials Program and the American Influences, 1962-76. CANADIAN BULLETIN OF MEDICAL HISTORY = BULLETIN CANADIEN D'HISTOIRE DE LA MEDECINE 2020; 37:23-49. [PMID: 32208108 DOI: 10.3138/cbmh.361-052019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Clinical cancer research in Canada entered a new phase in 1971. In that year, the National Cancer Institute of Canada agreed to initiate and support a multidisciplinary cooperative clinical trials program. The first collaborative randomized controlled trial (RCT) for the treatment of advanced Hodgkin's disease was launched in medical centres across the country in December 1971. Simultaneously, in the United States, the National Cancer Act came into effect. To what extent were these Canadian and American developments coincidental? I argue that the cooperative clinical trials program in Canada was timed to coincide with the US declaration of war on cancer, but it was not its corollary. Against the background of this American anti-cancer campaign, the cooperative clinical trials program emerged as a link between the strong radiotherapy tradition in Canada and the new trial infrastructure of chemotherapeutic regimes in the United States. The evolution of the Hodgkin's disease trial serves as a good example to demonstrate how growing collaboration among Canadian and American physician-investigators brought about a large-scale national study. The latter became a prototype of further cooperative oncological RCTs in Canada during the 1970s.
Collapse
Affiliation(s)
- Fedir Razumenko
- Department of Community Health Sciences, University of Calgary
| |
Collapse
|
5
|
Hart RI, Hallowell N, Harden J, Jesudason AB, Lawton J. Clinician-researchers and custodians of scarce resources: a qualitative study of health professionals' views on barriers to the involvement of teenagers and young adults in cancer trials. Trials 2020; 21:67. [PMID: 31924260 PMCID: PMC6954521 DOI: 10.1186/s13063-019-3942-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 11/28/2019] [Indexed: 12/15/2022] Open
Abstract
Background Equipoise and role conflict have been previously identified as important factors in professionals’ engagement with trials, inducing behaviours which can impact on recruitment. We explored these phenomena as potential explanations for the low levels of involvement of teenagers and young adults (TYA) with cancer in clinical trials in oncology. Methods We report findings from interviews with 30 purposively sampled direct-care professionals involved in delivering cancer care and/or facilitating clinical trials in Scotland. We undertook qualitative descriptive analysis, focussed on identifying key issues and themes. Results Interviewees largely identified as clinician–researchers and portrayed oncology as a specialty in which research was integral to care. They saw their primary responsibility as ensuring patients received the best treatment, but asserted that, in general, trials provided a vehicle for optimal care. Role conflict in its traditional form was rarely evident; however, other tensions were manifest. Professionals found the significant time costs of delivering trials difficult to reconcile with the increasing pressures on clinical services. They felt a responsibility to make prudent choices about the trials with which to engage. Guided by utilitarian principles, these choices were oriented towards benefiting the largest number of patients. This favoured trials in high volume diseases; as TYA tend to have rarer forms of cancer, professionals’ support for—and TYA’s access to—relevant trials was, by default, more limited. Conclusions Neither lack of individual equipoise nor experiences of traditional forms of role conflict accounted for the low levels of involvement of TYA with cancer in clinical trials. However, prominent tensions around the management of scarce resources provided an alternative explanation for TYA’s limited access to cancer trials. The prevailing approach to decision-making about whether and which trials to support was recognised as contributing to inequalities in access and care. Professionals’ choices, however, were made in the context of scarcity, and structured by incentives and sanctions understood by them as signalling governmental priorities. A franker discussion of the extent and distribution of the costs and benefits of trials work is needed, for change to be achieved.
Collapse
Affiliation(s)
- Ruth I Hart
- Usher Institute, University of Edinburgh, Edinburgh, EH8 9AG, UK.
| | - Nina Hallowell
- Wellcome Centre for Ethics and Humanities and Ethox Centre, Nuffield Department of Population Health, Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, OX3 7LF, UK
| | - Jeni Harden
- Usher Institute, University of Edinburgh, Edinburgh, EH8 9AG, UK
| | - Angela B Jesudason
- Royal Hospital for Sick Children, Department of Paediatric Haematology and Oncology, Sciennes Road, Edinburgh, EH9 1LF, UK
| | - Julia Lawton
- Usher Institute, University of Edinburgh, Edinburgh, EH8 9AG, UK
| |
Collapse
|
6
|
Atkinson P, Sheard S, Walley T. 'All the stars were aligned'? The origins of England's National Institute for Health Research. Health Res Policy Syst 2019; 17:95. [PMID: 31801552 PMCID: PMC6894247 DOI: 10.1186/s12961-019-0491-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 09/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2006, the research and development (R&D) activity of England's national healthcare system, the National Health Service, was reformed. A National Institute for Health Research (NIHR) was established within the Department of Health, the first body to manage this activity as an integrated system, unlocking significant increases in government funding. This article investigates how the NIHR came to be set up, and why it took the form it did. Our goal was a better understanding of 'how we got here'. METHODS We conducted oral history interviews with 38 key witnesses, held a witness seminar, and examined published and unpublished documents. RESULTS We conclude that the most important forces shaping the origin of NIHR were the growing impact of evidence-based medicine on service policies, the growth of New Public Management ways of thinking, economic policies favouring investment in health R&D and buoyant public funding for healthcare. We note the strong two-way interaction between the health research system and the healthcare system - while beneficial for the use of research, challenges for healthcare (such as stop-go funding) could also produce challenges for health research. CONCLUSIONS Understanding how and why England came to have a centralised health service research system alongside a long-established funder of biomedical research (the Medical Research Council) helps us interpret the significance of the English health research experience for other countries and helps English policy-makers better understand their present options. Learning lessons from the features of the English health research system calls for an understanding of the processes which shaped it. Firstly, the publicly funded, nationally organised character of healthcare promoted government interest in evidence-based medicine, made research prioritisation simpler and helped promote the implementation of findings. Secondly, the essential role of leadership by a group who valued research for its health impact ensured that new management methods (such as metrics and competitive tendering) were harnessed to patient benefit, rather than as an end in themselves. A policy window of government willingness to invest in R&D for wider economic goals and buoyant funding of the health system were also effectively exploited.
Collapse
Affiliation(s)
- Paul Atkinson
- Department of Public Health and Policy, University of Liverpool, Whelan Building, Quadrangle, Liverpool, L69 3GB United Kingdom
| | - Sally Sheard
- Department of Public Health and Policy, University of Liverpool, Whelan Building, Quadrangle, Liverpool, L69 3GB United Kingdom
| | - Tom Walley
- Department of Public Health and Policy, University of Liverpool, Whelan Building, Quadrangle, Liverpool, L69 3GB United Kingdom
| |
Collapse
|
7
|
Mould DR, Hutson PR. Critical Considerations in Anticancer Drug Development and Dosing Strategies: The Past, Present, and Future. J Clin Pharmacol 2019; 57 Suppl 10:S116-S128. [PMID: 28921645 DOI: 10.1002/jcph.983] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 06/19/2017] [Indexed: 01/26/2023]
|
8
|
Kerr A, Ross E, Jacques G, Cunningham‐Burley S. The sociology of cancer: a decade of research. SOCIOLOGY OF HEALTH & ILLNESS 2018; 40:552-576. [PMID: 29446117 PMCID: PMC5901049 DOI: 10.1111/1467-9566.12662] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Biomedicine is often presented as the driving force behind improvements in cancer care, with genomics the latest innovation poised to change the meaning, diagnosis, treatment, prevention and lived experience of cancer. Reviewing sociological analyses of a diversity of patient and practitioner experiences and accounts of cancer during the last decade (2007-17), we explore the experiences of, approaches to and understandings of cancer in this period. We identify three key areas of focus: (i) cancer patient experiences and identities; (ii) cancer risk and responsibilities and (iii) bioclinical collectives. We explore these sociological studies of societal and biomedical developments and how sociologists have sought to influence developments in cancer identities, care and research. We end by suggesting that we extend our understanding of innovations in the fields of cancer research to take better account of these wider social and cultural innovations, together with patients, activists' and sociologists' contributions therein.
Collapse
Affiliation(s)
- Anne Kerr
- School of Sociology and Social PolicyUniversity of LeedsUK
| | - Emily Ross
- The Usher InstituteEdinburgh Medical SchoolUniversity of EdinburghUK
| | - Gwen Jacques
- School of Sociology and Social PolicyUniversity of LeedsUK
| | | |
Collapse
|
9
|
Quirke VM. Tamoxifen from Failed Contraceptive Pill to Best-Selling Breast Cancer Medicine: A Case-Study in Pharmaceutical Innovation. Front Pharmacol 2017; 8:620. [PMID: 28955226 PMCID: PMC5600945 DOI: 10.3389/fphar.2017.00620] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 08/24/2017] [Indexed: 11/13/2022] Open
Abstract
Today, tamoxifen is one of the world's best-selling hormonal breast cancer drugs. However, it was not always so. Compound ICI 46,474 (as it was first known) was synthesized in 1962 within a project to develop a contraceptive pill in the pharmaceutical laboratories of ICI (now part of AstraZeneca). Although designed to act as an anti-estrogen, the compound stimulated, rather than suppressed ovulation in women. This, and the fact that it could not be patented in the USA, its largest potential market, meant that ICI nearly stopped the project. It was saved partly because the team's leader, Arthur Walpole, threatened to resign, and pressed on with another project: to develop tamoxifen as a treatment for breast cancer. Even then, its market appeared small, because at first it was mainly used as a palliative treatment for advanced breast cancer. An important turning point in tamoxifen's journey from orphan drug to best-selling medicine occurred in the 1980s, when clinical trials showed that it was also useful as an adjuvant to surgery and chemotherapy in the early stages of the disease. Later, trials demonstrated that it could prevent its occurrence or re-occurrence in women at high risk of breast cancer. Thus, it became the first preventive for any cancer, helping to establish the broader principles of chemoprevention, and extending the market for tamoxifen and similar drugs further still. Using tamoxifen as a case study, this paper discusses the limits of the rational approach to drug design, the role of human actors, and the series of feedback loops between bench and bedside that underpins pharmaceutical innovation. The paper also highlights the complex evaluation and management of risk that are involved in all therapies, but more especially perhaps in life-threatening and emotion-laden diseases like cancer.
Collapse
Affiliation(s)
- Viviane M. Quirke
- School of History, Philosophy and Culture, Faculty of Humanities and Social Sciences, Oxford Brookes UniversityOxford, United Kingdom
| |
Collapse
|
10
|
“Unsettling circularity”: Clinical trial enrichment and the evidentiary politics of chronic pain. BIOSOCIETIES 2017. [DOI: 10.1057/biosoc.2016.7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
11
|
Abstract
Following World War II (WWII), there was a new emphasis within genetics on studying the genetic composition of populations. This probably had a dual source in the growing strength of evolutionary biology and the new international interest in understanding the effects of radiation on human populations, following the atomic bombings in Japan. These global concerns were shared by Mexican physicians. Indeed, Mexico was one of the leading centers of this trend in human genetics. Three leading players in this story were Mario Salazar Mallén, Adolfo Karl, and Rubén Lisker. Their trajectories and the international networks in human genetics that were established after WWII, paved the way for the establishment of medical and population genetics in Mexico. Salazar Mallén's studies on the distribution and characterization of ABO blood groups in indigenous populations were the starting point while Karl's studies on the distribution of abnormal hemoglobin in Mexican indigenous populations showed the relationships observed in other laboratories at the time. It was Lisker's studies, however, that were instrumental in the development of population genetics in the context of national public policies for extending health care services to the Mexican population. In particular, he conducted studies on Mexican indigenous groups contributing to the knowledge of the biological diversity of human populations according to international trends that focused on the variability of human populations in terms of genetic frequencies. From the start, however, Lisker was as committed to the reconstruction of shared languages and practices as he was to building networks of collaboration in order to guarantee the necessary groundwork for establishing the study of the genetics of human populations in Mexico. This study also allows us to place Mexican science within a global context in which connected narratives describe the interplay between global trends and national contexts.
Collapse
|
12
|
Day S, Coombes RC, McGrath-Lone L, Schoenborn C, Ward H. Stratified, precision or personalised medicine? Cancer services in the 'real world' of a London hospital. SOCIOLOGY OF HEALTH & ILLNESS 2017; 39:143-158. [PMID: 27460935 DOI: 10.1111/1467-9566.12457] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
We conducted ethnographic research in collaboration with a large, research-intensive London breast cancer service in 2013-2014 so as to understand the practices and potential effects of stratified medicine. Stratified medicine is often seen as a synonym for both personalised and precision medicine but these three terms, we found, also related to distinct facets of treatment and care. Personalised medicine is the term adopted for the developing 2016 NHS England Strategy, in which breast cancer care is considered a prime example of improved biological precision and better patient outcomes. We asked how this biologically stratified medicine affected wider relations of care and treatment. We interviewed formally 33 patients and 23 of their carers, including healthcare workers; attended meetings associated with service improvements, medical decision-making, public engagement, and scientific developments as well as following patients through waiting rooms, clinical consultations and other settings. We found that the translation of new protocols based on biological research introduced further complications into an already-complex patient pathway. Combinations of new and historic forms of stratification had an impact on almost all patients, carers and staff, resulting in care that often felt less rather than more personal.
Collapse
Affiliation(s)
- Sophie Day
- Patient Experience Research Centre, School of Public Health, Imperial College London, UK
- Department of Anthropology, Goldsmiths, London, UK
| | | | - Louise McGrath-Lone
- Patient Experience Research Centre, School of Public Health, Imperial College London, UK
| | - Claudia Schoenborn
- Patient Experience Research Centre, School of Public Health, Imperial College London, UK
| | - Helen Ward
- Patient Experience Research Centre, School of Public Health, Imperial College London, UK
| |
Collapse
|
13
|
Bijker EM, Sauerwein RW, Bijker WE. Controlled human malaria infection trials: How tandems of trust and control construct scientific knowledge. SOCIAL STUDIES OF SCIENCE 2016; 46:56-86. [PMID: 26983172 DOI: 10.1177/0306312715619784] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Controlled human malaria infections are clinical trials in which healthy volunteers are deliberately infected with malaria under controlled conditions. Controlled human malaria infections are complex clinical trials: many different groups and institutions are involved, and several complex technologies are required to function together. This functioning together of technologies, people, and institutions is under special pressure because of potential risks to the volunteers. In this article, the authors use controlled human malaria infections as a strategic research site to study the use of control, the role of trust, and the interactions between trust and control in the construction of scientific knowledge. The authors argue that tandems of trust and control play a central role in the successful execution of clinical trials and the construction of scientific knowledge. More specifically, two aspects of tandems of trust and control will be highlighted: tandems are sites where trust and control coproduce each other, and tandems link the personal, the technical, and the institutional domains. Understanding tandems of trust and control results in setting some agendas for both clinical trial research and science and technology studies.
Collapse
|
14
|
Scheffler RW. Managing the future: the Special Virus Leukemia Program and the acceleration of biomedical research. STUDIES IN HISTORY AND PHILOSOPHY OF BIOLOGICAL AND BIOMEDICAL SCIENCES 2014; 48 Pt B:231-49. [PMID: 25459347 DOI: 10.1016/j.shpsc.2014.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 09/23/2014] [Indexed: 05/05/2023]
Abstract
After the end of the Second World War, cancer virus research experienced a remarkable revival, culminating in the creation in 1964 of the United States National Cancer Institute's Special Virus Leukemia Program (SVLP), an ambitious program of directed biomedical research to accelerate the development of a leukemia vaccine. Studies of cancer viruses soon became the second most highly funded area of research at the Institute, and by far the most generously funded area of biological research. Remarkably, this vast infrastructure for cancer vaccine production came into being before a human leukemia virus was shown to exist. The origins of the SVLP were rooted in as much as shifts in American society as laboratory science. The revival of cancer virus studies was a function of the success advocates and administrators achieved in associating cancer viruses with campaigns against childhood diseases such as polio and leukemia. To address the urgency borne of this new association, the SVLP's architects sought to lessen the power of peer review in favor of centralized Cold War management methods, fashioning viruses as "administrative objects" in order to accelerate the tempo of biomedical research and discovery.
Collapse
|
15
|
Montgomery CM. Protocols and participatory democracy in a 'North-South' product development partnership. SOCIOLOGY OF HEALTH & ILLNESS 2012; 34:1053-1069. [PMID: 22384948 DOI: 10.1111/j.1467-9566.2011.01455.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Global product development partnerships (PDPs) for new health technologies have become an increasingly important part of the science and development landscape over the past two decades. Polarised positions are adopted by those scrutinising the power and governance of these public-private formations; on the one hand, they are seen as successful social technology innovations, on the other as regressive and imperialistic regimes of neo-colonialism. Answering recent calls for research to examine the actors, governance, context and dynamics of PDPs, this article presents a sociological case study of one particular partnership, the Microbicides Development Programme (MDP). Interviews were conducted with a cross-section of programme staff in the UK and Zambia, and discourses analysed through a Foucauldian lens of governmentality. This article suggests that two tools of government were central to MDP's cohesiveness: institutional discourses of participatory democracy and capacity building and scientific protocols. Through these material-semiotic tools, the scientific community, junior operational researchers and the funder were successfully enrolled into the programme and governed by a central body based in the UK. This article draws on Nikolas Rose's work to discuss these socio-scientific discourses as technologies of government, and provides a non-dualistic account of power and governance in a North-South PDP.
Collapse
Affiliation(s)
- Catherine M Montgomery
- Institute for Science, Innovation and Society, School of Anthropology and Museum Ethnography, University of Oxford.
| |
Collapse
|
16
|
Baszanger I. One more chemo or one too many? Defining the limits of treatment and innovation in medical oncology. Soc Sci Med 2012; 75:864-72. [PMID: 22658622 DOI: 10.1016/j.socscimed.2012.03.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 03/06/2012] [Accepted: 03/08/2012] [Indexed: 11/17/2022]
Abstract
During the past few years, debates have frequently erupted in oncology journals regarding the question of whether to prolong or end treatment. These debates have been informed by developments from both within and outside the field. Within Bioethics, some writers have put forward a number of principles for judging the legitimacy of medical interventions, notably that of patient autonomy. Broad social and political developments have also profoundly affected medical practices at the end of life. Though therapeutic options have evolved, whether to stop or to pursue treatment in the face of certain death has been a central issue in medical oncology since the early 1950s. A critical appraisal of the history of this issue can help us to better understand the tangled relationship(s) between innovation, "cure," death, and the symptoms and subjective experiences of sufferers. This paper addresses an aspect of this complex problem, namely how limits are established regarding both treatment and therapeutic innovation near the end of life. Utilizing a grounded theory and situational analysis approach it traces how the issues at stake were defined and the ways in which the dilemma was progressively transformed as a result of the combined effects of a proliferating number of stakeholders, molecules, instruments, and techniques. It discusses three different moments, as they epitomize how the links between chemotherapy and palliation were construed through the evolving forms of clinical research and innovative therapies.
Collapse
|
17
|
Lyng K, Pedersen B. Participatory design for computerization of clinical practice guidelines. J Biomed Inform 2011; 44:909-18. [DOI: 10.1016/j.jbi.2011.05.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 05/03/2011] [Accepted: 05/15/2011] [Indexed: 01/22/2023]
|
18
|
García-Sancho M. Academic and molecular matrices: a study of the transformations of connective tissue research at the University of Manchester (1947-1996). STUDIES IN HISTORY AND PHILOSOPHY OF BIOLOGICAL AND BIOMEDICAL SCIENCES 2011; 42:233-45. [PMID: 21486662 PMCID: PMC3677089 DOI: 10.1016/j.shpsc.2010.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Revised: 09/17/2010] [Indexed: 05/30/2023]
Abstract
This paper explores the different identities adopted by connective tissue research at the University of Manchester during the second half of the 20th century. By looking at the long-term redefinition of a research programme, it sheds new light on the interactions between different and conflicting levels in the study of biomedicine, such as the local and the global, or the medical and the biological. It also addresses the gap in the literature between the first biomedical complexes after World War II and the emergence of biotechnology. Connective tissue research in Manchester emerged as a field focused on new treatments for rheumatic diseases. During the 1950s and 60s, it absorbed a number of laboratory techniques from biology, namely cell culture and electron microscopy. The transformations in scientific policy during the late 70s and the migration of Manchester researchers to the US led them to adopt recombinant DNA methods, which were borrowed from human genetics. This resulted in the emergence of cell matrix biology, a new field which had one of its reference centres in Manchester. The Manchester story shows the potential of detailed and chronologically wide local studies of patterns of work to understand the mechanisms by which new biomedical tools and institutions interact with long-standing problems and existing affiliations.
Collapse
Affiliation(s)
- Miguel García-Sancho
- Department of Science, Technology and Society, Spanish National Research Council (CSIC), Calle Albasanz, 26-28, 28037 Madrid, Spain.
| |
Collapse
|
19
|
Band PR. The birth of the subspecialty of medical oncology and examples of its early scientific foundations. J Clin Oncol 2010; 28:3653-8. [PMID: 20567013 DOI: 10.1200/jco.2010.29.5261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
"Passion is not accepting defeat."--Emil Frei III. In the early 1950s, an experimental and clinical program characterized by unique cross-fertilization was developed. The clinical importance of experimental animal models in drug screening and in establishing key chemotherapy concepts and the role of the pioneers of medical oncology in the design of the various phases of drug trials, using childhood acute leukemia and breast cancer as models, are discussed. Over a short time and with only a few drugs, principles of chemotherapy were laid out, which led to cures in such diseases as childhood acute leukemia and Hodgkin's disease and to improved disease-free survival in breast cancer. It is these and other achievements that paved the way to medical oncology. At the instigation of the American Society of Clinical Oncology (ASCO), the American Board of Internal Medicine made inquiries about a subspecialty in oncology. ASCO and B. J. Kennedy, MD, played key roles in the events leading to the official recognition of medical oncology as a new subspecialty of internal medicine in 1972.
Collapse
|
20
|
Sifer-Rivière L, Girre V, Gisselbrecht M, Saint-Jean O. Physicians' perceptions of cancer care for elderly patients: a qualitative sociological study based on a pilot geriatric oncology program. Crit Rev Oncol Hematol 2010; 75:58-69. [PMID: 20510625 DOI: 10.1016/j.critrevonc.2010.04.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2009] [Revised: 03/30/2010] [Accepted: 04/01/2010] [Indexed: 01/15/2023] Open
Abstract
The aim of this study was to document physicians' perceptions of cancer care for elderly patients within an oncogeriatric coordination pilot unit (UPCOG) created in Paris, France. We focused on how physicians apply new cancer care practices, how they establish new teamwork, and their experience of oncogeriatrics in everyday practice. Qualitative methods were used, including a literature review, observation of working sessions in the oncogeriatric pilot unit, and semi-structured interviews with 28 physicians. The results show how physicians' differing perceptions of geriatric oncology can hinder routine collaboration.
Collapse
Affiliation(s)
- Lynda Sifer-Rivière
- Centre de recherche médecine, sciences, santé et société, Site CNRS, 7 Rue Guy Môquet, Villejuif Cédex, France.
| | | | | | | |
Collapse
|
21
|
Abraham J, Davis C. Drug evaluation and the permissive principle: continuities and contradictions between standards and practices in antidepressant regulation. SOCIAL STUDIES OF SCIENCE 2009; 39:569-598. [PMID: 19848109 DOI: 10.1177/0306312709103480] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Pharmaceuticals are not permitted on to the market unless they are granted regulatory approval. The regulatory process is, therefore, crucial in whether or not a drug is widely prescribed. Regulatory agencies have developed standards of performance that pharmaceuticals are supposed to meet before entering the market. Regulation of technologies is often discussed by reference to the precautionary principle. In contrast, this paper develops the concept of the 'permissive principle' as a way of understanding the departure of regulators' practices from standards of drug efficacy to which regulatory agencies themselves subscribe. By taking a case study of antidepressant regulation in the UK and the USA, the mechanisms of permissive regulatory practices are examined. An STS methodology of both spatial (international) and temporal comparisons of regulatory practices with regulatory standards is employed to identify the nature and extent of the permissive regulation. It is found that the permissive principle was adopted by drug regulators in the UK and the USA, but more so by the former than the latter. Evidently, permissive regulation, which favours the commercial interests of the drug manufacturer, but is contrary to the interests of patients, may penetrate to the heart of regulatory science. On the other hand, permissive regulation of specific drugs should not be regarded as an inevitable result of marketing strategies and concomitant networks deployed by powerful pharmaceutical companies, because the extent of permissive regulation may vary according to the intra-institutional normative commitments of regulators to uphold their technical standards against the commercial interests of the manufacturer. Likely sociological factors that can account for such permissive regulatory practices are 'corporate bias', secrecy and excessive regulatory trust in the pharmaceutical industry in the UK, political expediency and ideological capture in the USA, combined in both countries with some regulatory deference to the clinical autonomy of the psychiatry profession.
Collapse
Affiliation(s)
- John Abraham
- Department of Sociology, Centre for Research in Health and Medicine, University of Sussex, Falmer, Brighton, UK.
| | | |
Collapse
|
22
|
Keating P, Cambrosio A. Who's minding the data? Data Monitoring Committees in clinical cancer trials. SOCIOLOGY OF HEALTH & ILLNESS 2009; 31:325-342. [PMID: 19055588 DOI: 10.1111/j.1467-9566.2008.01136.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
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.
Collapse
|
23
|
Weisz G, Cambrosio A, Keating P, Knaapen L, Schlich T, Tournay VJ. The emergence of clinical practice guidelines. Milbank Q 2007; 85:691-727. [PMID: 18070334 PMCID: PMC2690350 DOI: 10.1111/j.1468-0009.2007.00505.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
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.
Collapse
|