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The Alchemy of Clinical Trials

Published online by Cambridge University Press:  01 March 2007

Catherine M. Will
Catherine M. Will
Affiliation:
Department of Sociology, University of Sussex, Falmer, East Sussex BN1 9SN, UK E-mail: c.will@sussex.ac.uk
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Abstract

This article considers the complex construction of randomized controlled trials that lies behind the rhetoric of the gold standard. Drawing on insights from Science and Technology Studies and empirical material, I argue that trials in the field of cardiovascular disease prevention are constituted as ‘research’ rather than ‘science’. In these examples, control emerges out of a dual concern with practices of purification and involvement of aspects of the world outside the experiment, as the designers of trials aspire to relevance as well as rigour. Such strategies of ‘contextualization’ mean that trials are more like alchemy than assay, proceeding by complex moves to transform ‘base’ matters rather than distilling elements of clinical practice.

Keywords

boundary workclinical trialcontextualization RCTtransaction space
Type
Articles
Information
BioSocieties , Volume 2 , Issue 1: Special Issue: The Construction and Governance of Randomised Controlled Trials , March 2007 , pp. 85 - 99
Copyright
Copyright © London School of Economics and Political Science 2007

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References

Baker, R., Fraser, R.C., Stone, M., Lambert, P., Stevenson, K., & Shiels, C. (2003). Randomised controlled trial of the impact of guidelines, prioritised review criteria and feedback on implementation of recommendations for angina and asthma. British Journal of General Practice, 53, 284–291.Google Scholar
Berg, M. (1997). Rationalizing medical work: Decision-support techniques and medical practices. Cambridge, MA: MIT Press.Google Scholar
Brown, B.W. (1984). The randomized clinical trial (Printed with following discussion). Statistics in Medicine, 3, 307–311.CrossRefGoogle Scholar
Callon, M., & Rabeharisoa, V. (2003). Research in the wild and the shaping of new social identities. Technology in Society, 25, 193–204.CrossRefGoogle Scholar
Cambrosio, A., Keating, P., Schlich, T., & Weisz, G. (2006) Regulatory objectivity and the generation and management of evidence in medicine. Social Science & Medicine, 63, 189–99.Google Scholar
Campbell Collaboration (n.d.) About the Campbell Collaboration. URL (acessed January 2007): www. campbellcollaboration.org/About.aspGoogle Scholar
Campbell, N., Thain, J., Deans, H., George, R., Lewis, D., Rawles, J.M. et al. (1998). Secondary prevention clinics for coronary heart disease: randomised trial of effect on health. British Medical Journal, 316, 1434–1437.CrossRefGoogle ScholarPubMed
Campbell, M., Fitzpatrick, R., Haines, A., Kinmouth, A.-L., Sandercock, P., Spiegelhalter, D. et al. (2000). Framework for design and evaluation of complex interventions to improve health. British Medical Journal, 321, 694–696.CrossRefGoogle ScholarPubMed
Cochrane, A. (1972). Effectiveness and efficiency: Random reflections on health services. London: Nuffield Provincial Hospitals Trust.Google Scholar
Cochrane, A., & Blythe, M. (1989). One man’s medicine: An autobiography of Professor Archie Cochrane. London: British Medical Journal.Google Scholar
COREC (2006). Differentiating audit, service evaluation and research. URL (accessed January 2007): www.corec.org.uk/applicants/help/docs/Audit_or_Research_table.pdfGoogle Scholar
Cupples, M.E., & McKnight, A. (1994). Randomised controlled trial of health promotion in general practice for patients at high cardiovascular risk. British Medical Journal, 309, 993–996.CrossRefGoogle ScholarPubMed
De Vries, R., & Lemmens, T. (2006). The social and cultural shaping of medical evidence: Case studies from pharmaceutical research and obstetric science. Social Science & Medicine, 62, 2694–2706.CrossRefGoogle ScholarPubMed
Department of Health (2000). National Service framework on coronary heart disease. London: HMSO.Google Scholar
Eccles, M., McColl, E., Steen, N., Rousseau, N., Grimshaw, J., Parkin, D. et al. (2002). Effect of computerised evidence-based guidelines on management of asthma and angina in adults in primary care: Cluster randomised controlled trial. British Medical Journal, 315, 941.CrossRefGoogle Scholar
Epstein, S. (1996). Impure science: AIDS, activism and the politics of knowledge. Berkeley: University of California Press.Google ScholarPubMed
Feder, G., Griffiths, C., Eldridge, S., & Spence, M. (1999). Effect of postal prompts to patients and general practitioners on the quality of primary care after a coronary event (POST): Randomised controlled trial. British Medical Journal, 318, 1522–1526.CrossRefGoogle ScholarPubMed
Garcia, J., Elbourne, D., & Snowdon, C. (2004). Equipoise: A case study of the views of clinicians involved in two neonatal trials. Clinical Trials, 4, 170–178.CrossRefGoogle Scholar
Gieryn, T.F. (1983). Boundary-work and the demarcation of science from nonscience: Strains and interests in professional ideologies of scientists. American Sociological Review, 48, 781–795.Google Scholar
Heart Protection Study Collaborative Group (2002a). Questions and answers. URL (accessed January 2007): www.ctsu.ox.ac.uk/~hps/June02QandA.shtmlGoogle Scholar
Heart Protection Study Collaborative Group (2002b). MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: A randomised placebo-controlled trial. The Lancet, 360, 7–22.CrossRefGoogle Scholar
Jolly, K., Bradley, F., Sharp, S., Smith, H., Thompson, S, Kinmouth, A.-L. et al. on behalf of the SHIP collaborative group (1999). Randomised controlled trial of follow-up care in general practice of patients with myocardial infarction and angina: Final results of the Southampton heart integrated care project (SHIP). British Medical Journal, 318, 706–711.CrossRefGoogle ScholarPubMed
Jones, D.S. (2000) Vision of a cure: Visualization, clinical trials, and controversies in cardiac therapeutics, 1968–1998. Isis, 91, 504–541.Google Scholar
Knorr Cetina, K. (1999). Epistemic cultures: How the sciences make knowledge. Cambridge, MA: Harvard University Press.CrossRefGoogle Scholar
Latour, B. (1987). Science in action. Milton Keynes: Open University Press.Google Scholar
Latour, B. (1988) The Pasteurisation of France. Cambridge, MA: Harvard University Press.Google Scholar
Latour, B. (1993). We have never been modern, trans. Porter, C.Cambridge, MA: Harvard University Press.Google Scholar
Latour, B. (1998). From the world of science to the world of research? Science, 280, 208–209.Google Scholar
Law, J. (2004). After method: Mess in social science research. London: Routledge.Google Scholar
Marks, H.M. (1997). The progress of experiment: Science and therapeutic reform in the United States, 1900–1990. Cambridge: Cambridge University Press.Google Scholar
Marks, H.M. (2000). Trust and mistrust in the marketplace: Statistics and clinical research, 1945–1960. History of Science, 38, 343–355.CrossRefGoogle ScholarPubMed
May, C., Rapley, T., Moreira, T., Finch, T., & Heaven, B. (2006). Technogovernance: Evidence, subjectivity and the clinical encounter in primary care medicine. Social Science & Medicine, 62, 1022–1030.Google Scholar
Medical Research Council (2001) Press release for the Heart Protection Study. URL (accessed August 2005): www.mrc.ac.uk/txt/index/public-interest/public-news_centre/public-press_office/public-press_releases_2001/public-13_november_2001b.htmGoogle Scholar
Moher, M., Yudkin, P., Wright, L., Turner, R., Fuller, A., Schofield, T. et al. for the Assessment of Implementation Strategies (ASSIST) trial collaborative group (2001). Cluster randomised controlled trial to compare three methods of promoting secondary prevention of coronary heart disease in primary care. British Medical Journal, 322, 1–7.CrossRefGoogle ScholarPubMed
Moreira, T. (2005). Diversity in clinical guidelines: The role of repertoires of evaluation. Social Science & Medicine, 60, 1975–1985.CrossRefGoogle ScholarPubMed
Muir, J., Mant, D., Jones, L., & Yudkin, P. on behalf of the Imperial Cancer Research Fund OXCHECK study group (1994). Effectiveness of health checks conducted by nurses in primary care: Results of the OXCHECK study after one year. British Medical Journal, 308, 308–312.Google Scholar
Muir, J., Lancaster, T.Jones, L., & Yudkin, P. on behalf of the Imperial Cancer Research Fund OXCHECK study group (1995). Effectiveness of health checks conducted by nurses in primary care: Final results of the OXCHECK. British Medical Journal, 310, 1099–1104.Google Scholar
Nowotny, H., Scott, P., & Gibbons, M. (2001). Re-thinking science: Knowledge and the public in an age of uncertainty. Cambridge: Polity Press.Google Scholar
Porter, T. (1995). Trust in numbers: The pursuit of objectivity in science and public life. Princeton, NJ: Princeton University Press.Google Scholar
Richards, E. (1991). Vitamin C and cancer: Medicine or politics? London: Macmillan.Google Scholar
Riles, A. (2001). The network inside out. Ann Arbor: University of Michigan Press.Google Scholar
Rothwell, P. (2005). Treating individuals 1. External validity of randomised controlled trials: ‘To whom do the results of this trial apply?’, The Lancet, 365, 82–93.Google Scholar
Schaffer, S. (2005). Public experiments. In Latour, B. & Weibel, P. (Eds), Making things public: Atmospheres of democracy, 298–307. Cambridge, MA: MIT Press.Google Scholar
Shepherd, J., Cobbe, S.M., Ford, I., Isles, C.G., Lormier, A.R., Macfarlane, et al. for the West of Scotland Coronary Prevention Study Group (1995). Prevention of coronary heart disease with pravastatin in men with hypercholesterolaemia. New England Journal of Medicine, 335, 1001–1009.Google Scholar
Star, S.L., & Griesemer, J.R. (1989). Institutional ecology, translations and boundary objects: Amateurs and professionals in Berkeley’s museum of vertebrate zoology. Social Studies of Science, 19, 387–420.Google Scholar
Steptoe, A., Doherty, S., Rink, E., Kerry, S., Kendrick, T., & Hilton, S. (1999). Behavioural counselling in general practice for the promotion of healthy behaviour among adults at increased risk of coronary heart disease: Randomised trial. British Medical Journal, 319, 943–948.Google Scholar
Timmermans, S., & Berg, M. (1997). Standardisation in action: Achieving local universality through medical protocols. Social Studies of Science, 27, 273–305.Google Scholar
Timmermans, S., & Berg, M. (2003). The gold standard: The challenge of evidence-based medicine and standardization in health care. Philadelphia, PA: Temple University Press.Google Scholar
West of Scotland Coronary Prevention Study Group (1992). A coronary primary prevention study of Scottish men aged 45–64 years: Trial design. Journal of Clinical Epidemiology, 45, 849–860.CrossRefGoogle Scholar
Wood, D.A., Kinmouth, A.-L., Davies, G.A., Yarwood, J., Thompson, S.G., Pyke, S.D.M. et al. for the Family Heart Study Group (1994). Randomised controlled trial evaluating cardiovascular screening and intervention in general practice: Principal results of British family heart study. British Medical Journal, 308, 313–320.Google Scholar