La fabrique de la preuve biomédicale

Epistemic, regulatory, material and political imbrications in the making of biomedical evidence 

Call for Paper 

14-15 October 2020 - Bordeaux, France.

Organized by Thomas Bonnin and Charlotte Brives, ANR-funded project “Anthropophages”, Centre Emile Durkheim, Université de Bordeaux.

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Workshop description

Biomedical evidence emerges at the intersection of knowledge-making practices, existing norms and regulations, the materiality of the tested therapy as well as pragmatic and political aims.

In today’s biomedicine, randomized controlled trials (RCTs) are considered as the “gold standard” for the evaluation of a therapy’s safety and efficiency. The use of RCTs has become widespread in the second half of the 20th century. During this period, regulations and modes of productions have made this form of evidence indispensable to any marketing authorization for therapeutic products in Western medicine (Marks 2000).

While appraising the epistemic worth of RCTs, its hegemonic importance in today’s biomedical practice has also been criticized. The external validity of its results has been criticized on epistemic (Cartwright 2007) and socio-anthropological (Brives 2018) grounds. RCTs’ statistical objectivity is built over patient populations made commensurable, at the expense of the latter’s “local biologies” relegated to the context (Brives et al. 2016). Alternatively, case reports, which foreground the specifics of a given situation, have recently been argued to play important evidential roles (Ankeny 2014).

It would be a mistake, however, to consider RCTs as a rigidly determined procedure, with no room for maneuvering. Methodological and ontological commitments can be reflected at the level of choices for controls, types of intervention and measures of effectiveness, leaving a degree of malleability in these procedures (Stegenga 2018). There have also been recent innovations, such as “n of 1” trials (Lillie et al. 2011), which open the possibility to accommodate cases where large populations cannot be gathered.

The materiality of the tested therapies also interferes with these practices. For instance, phage therapy, the use of bacteriophage viruses to treat bacterial infections, has cumulated successful case reports for over a century. And yet, it still has to gain support from RCTs. Their viral nature, thus their mode of action, makes phages difficult to conciliate with modes of evidential production tailored to therapeutic molecules, such as antibiotics.

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Call for Paper

In this workshop, we are keen to make apparent the multidimensional constitution of biomedical evidence by an exploration of cases of different therapies from 20th and 21st-century biomedicine. This interdisciplinary workshop welcomes contributions from across the spectrum of social sciences (historians, philosophers, sociologists, anthropologists).

The format of the workshop contribution is a 30-minutes discussion of short papers (2,500-3,000 words) circulated prior to the event. This will facilitate discussion and the co-production of a collective output.

We welcome submissions of abstracts (250 to 500 words) until the 30th April 2020. For applications or any further questions, please contact Thomas Bonnin (thomas.bonnin.hps@gmail.com). Notifications of acceptance will be sent on the 15th May 2020. Pre-circulated papers are expected by the 31st July 2020.

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References

Ankeny R.A. (2014), “The Overlooked Role of Cases in Causal Attribution in Medicine”, Philosophy of Science 81: 999-1011

Brives C., Le Marcis F., Sanabria E. (2016), “What’s in a Context? Tenses and Tensions in Evidence-Based Medicine”, Medical Anthropology 35(5): 369-376

Brives C. (2018), “The myth of a naturalized male circumcision: Heuristic context and the production of scientific objects”, Global Public Health 13(11): 1599-1611

Cartwright N. (2007), “Are RCTs the gold standard?”, BioSocieties 2(1): 11-20

Lillie E.O. et al. (2011), “The n-of-1 clinical trial: the ultimate strategy for individualizing medicine?”, Personalized medicine 8(2): 161-173.

Marks H.M. (2000), The progress of experiment: Science and Therapeutic Reform in the United States, 1900-1990, Cambridge University Press

Stegenga J. (2018), Medical Nihilism, Oxford University Press --