Stefano Crabu, Dalla molecola al paziente. La biomedicina nella società contemporanea, Il Mulino, 2017
10.6092/issn.2038-3460/17466
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Lorenzo Beltrame
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Tecnoscienza – Italian Journal of Science & Technology Studies
Stefano Crabu, From the Molecule to the Patient. Biomedicine in Contemporary Society, Il Mulino, 2017
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Book Reviews
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Lorenzo Beltrame
2020/11/12
10.6092/issn.2038-3460/17466
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Stefano Crabu, From the Molecule to the Patient. Biomedicine in Contemporary Society, Il Mulino, 2017
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Book Review                                                                  85
instrumental in opening up important discussions among actors such as
researchers, developers, designers, students, or policymakers. Indeed, the
author’s clear and down to earth writing style makes this book very en-
gaging for anyone interested in how algorithms and data practices embed
forms of social injustice and how these can be considered when imagining
better futures.

References
Binns, R. (2018) Algorithmic accountability and public reason, in “Philosophy
       and Technology”, 31 (4), pp. 543-556.
D'Ignazio, C. and Klein, L. F. (2020) Data feminism, Cambridge, MA, MIT
       Press.
Eubanks, V. (2018) Automating inequality: How high-tech tools profile, police,
      and punish the poor, New York, St. Martin's Press.
Gillespie, T. (2012) Can an algorithm be wrong?, in “Limn”, 1 (2).
Seaver, N. (2017) Algorithms as culture: Some tactics for the ethnography of al-
        gorithmic systems, in “Big Data and Society”, 4 (2), pp. 1-12.
Woolgar, S. (1997) The Luddites: diablo ex machine, in K. Grint and S. Woolgar
      The Machine at Work: Technology, Work and Organization, Cambridge,
      Polity Press.



                                      ***
    Stefano Crabu
Dalla molecola al paziente. La biomedicina nella società contemporanea
[From the Molecule to the Patient. Biomedicine in Contemporary Society],
Bologna, Il Mulino, 2017, pp. 179

Lorenzo Beltrame Università di Trento

    “From bench to bedside” is the motto of the emerging translational
research in current biomedicine. In the biomedical literature, translation-
al research is promoted as a strategic and efficient way to implement the
novel discoveries of biological science in clinical practices, and to incor-
porate clinical observations back to laboratory science. In Science and
Technology Studies (STS) and in social studies of biomedicine, transla-
tional research is addressed as a space of problematization instead, which
invests important transformations in the articulation of clinical and ex-
perimental practices as well as discourses and epistemologies, the genera-
tion of novel biological entities and, finally, the making of subjectivities.
86                                                            Tecnoscienza – 11 (1)

    In Dalla molecola al paziente, Stefano Crabu introduces the Italian
reader to the STS discussion on what is often called precision or person-
alized medicine. While in the biomedical literature “precision” and “per-
sonalized” neutrally refer to the application of genomic knowledge for
the development of targeted, patient-specific therapies, in STS these
terms are instead problematized. Crabu contributes to this effort of prob-
lematization, through an original ethnographical analysis in two strategic
sites of translational medicine: an institute specialized in clinical research
on cancer and a laboratory working in the emerging field of nanomedi-
cine. Crabu shows how these sites are problematic spaces where the insti-
tutional boundaries of care and knowledge production are blurred. He
thus explores the complex epistemological and pragmatic realignments of
clinical and research practices that characterize translational medicine.
    In the first chapter, Crabu sets the analytical framework by discussing
the main theoretical approaches in the sociology of medicine, health, and
illness and in the social studies of contemporary biomedicine. Here
Crabu combines the STS understanding of laboratory practices with
some central notions in the social studies of biomedicine, and in particu-
lar with the theory of biomedicalization developed by Adele Clarke and
colleagues (2010). This move allows to grasp the complex transfor-
mations occurring in contemporary biomedicine, including what Clarke
and colleagues called the “technoscientization” of biomedical knowledge
production and clinical practice. Technoscientization is what enables the
insertion of STS analysis of laboratory practices into the social studies of
biomedicine, through another important analytical notion largely used in
this literature, namely the concept of biomedical platforms developed by
Keating and Cambrosio (2003). Covering semantically “natural and artifi-
cial entities, material artifacts and their blueprints, technical and political,
material and symbolic referents”, biomedical platforms are “way[s] of
arranging things in both a material and a discursive sense… the basis for
the organization of activities” (Keating and Cambrosio 2003, 345-6). The
concept of biomedical platforms has been introduced to account for the
growing importance of biology in current medicine and the clinics, as bi-
ology has become “the ultimate description and account of disease ori-
gins and mechanisms” (Keating and Cambrosio 2003, 354). It is therefore
particularly apt to understand the institutional, pragmatic, and epistemo-
logical transformations characterizing the current biomedicine, especially
in fields like translational research. In fact, the analytical framework de-
veloped by Crabu in this research is strongly indebted with the notion of
biomedical platforms and in general to the work of Keating and Cambro-
sio on the intersection of the new genetics with cancer research and clini-
cal treatment.
    A third relevant concept largely adopted by Crabu, is that of molecu-
larization (Rose 2007), namely the re-inscription of the biological into the
mechanisms and dynamics of the molecular entities of the human ge-
Book Review                                                                 87
nome. Molecularization, moreover, accounts also for the pervasive use of
information technologies in contemporary biomedicine, as well as for the
articulation of the molecular in informational terms, that enables the de-
ployment of genomics and post-genomics knowledge in addressing
health, illness, and therapies targeted on the patient’s genetic specificities.
Molecularization, finally, has important implications in the re-making of
bodies as biomedical objects and of patients as experimental subjects. Re-
ferring to biomedicalization, biomedical platforms, and molecularization,
Crabu investigates what translational medicine implies in terms of the
emerging novel articulations and intersections of clinical and experi-
mental practices. The theoretical reflection on these articulations is em-
pirically grounded on the analysis of the practices situated in specific sites
of treatment and research, where biomedicine is in the making.
     The second chapter is thus devoted to an ethnographical analysis in
an Italian medical institute specialized in cancer care and research. Here,
by studying what he calls a “translational biomedical platform” (p. 74) in
the making, Crabu explores the interconnection of care, clinical research,
and experimental development. This valuable analysis is articulated along
two interconnected axes. The first axis concerns the re-arrangement of
care and clinical research practices in a translational framework. This
means that the traditional routines in patients’ treatments are reshaped
according to the protocols for the research on molecular biomarkers. The
second axis refers to the transformations investing patients and their bod-
ies. By combining the reflection on molecularization and on clinical labor
(Waldby and Cooper 2014), Crabu shows how patients’ bodies are re-
constituted into a flow of mobile biological samples, parameters, and bio-
information, that can be treated in vitro, in vivo, and in silico. The body is
fragmented and rewritten through a complex technoscientific apparatus
of molecular quantification. In this way, the individual patient is convert-
ed into an experimental subject enrolled in the process of bio-knowledge
production.
     The adjustments of laboratory knowledge to clinical activities and the
related re-arrangements of the everyday procedures of care and patients
monitoring, according to the requirements of scientific research, are en-
capsulated in the original notion of technomimicry. This notion is the
main theoretical contribution of Crabu to social studies of biomedicine.
Crabu distinguishes between clinical technomimicry and experimental
technomimicry. The first one captures the “cognitive, material, and tech-
nological resources” operationalized in the situated everyday practices
that make “scientific research epistemologically consistent with clinical
action” (p. 69). The second refers to the ways “the clinic locally re-adjusts
its routines and practices” to the norms and methodologies of the scien-
tific laboratory (p. 74). According to Crabu, technomimicry is what
makes the biomedical platform of translational medicine working, by
providing the medical experts with the operative logic for producing clin-
88                                                          Tecnoscienza – 11 (1)

ical data and samples that can be used in the laboratory setting. Techno-
mimicry, in its clinical and experimental acceptation, is the analytical de-
vice that enables to grasp how translational biomedical platforms are
concretely and locally enacted and how the practices of care interpene-
trate technoscientific research and innovation.
     In the third chapter, Crabu explores the field of nanomedicine, that is
the combination of nanotechnologies with the biotechnological design of
new entities aimed at improving drug delivery and developing novel mol-
ecules to treat cancer. Here, the analytical framework is enriched with the
contribution of the so-called sociology of technoscientific expectations
(Brown and Michael 2003). Largely used in the analysis of emerging and
future-oriented technoscientific innovations, this approach is suitable for
investigating how discursive spaces of future promises and technoscien-
tific imaginaries are enacted to shape and orient the course of action of
research and innovation. The sociology of technoscientific expectations
allows Crabu to deploy the notions of biomedical platforms and techno-
mimicry for an analysis of future-oriented biomedical technologies. In
this way, Crabu investigates the articulation of practices, discourses, and
biological and technological objects in the everyday activities of a labora-
tory working on prospective biotechnological applications.
     In the final chapter Crabu goes back to STS and social studies of bi-
omedicine to theoretically discuss the implications of translational bio-
medical platforms. The ethnographical analysis undertaken in the previ-
ous chapters enables the identification of four trajectories that are reshap-
ing the contemporary biomedical landscape: 1) the making of a hybrid
space of increasing interaction between the laboratory and the clinical
setting and the related technological and organizational arrangements en-
abling the coordination among different disciplinary fields; 2) the manip-
ulation of the biological and the life itself; 3) the redefinition of the role
of the patient as a central actor in nowadays biomedical practices; 4) the
transformation of the roles, expertise, and identities of medical, research,
and health professionals involved in contemporary biomedicine. The im-
plications of these four trajectories are discusses along two axes.
     The first one, centered on Crabu’s notion of technomimicry, focuses
on the articulation and the assemblage of knowledge, practices, and tech-
nological objects. Translational medicine is thus not represented as mere-
ly a strategy for improving the application of genomic and post-genomic
knowledge and techniques to the clinic, as in the biomedical literature.
Rather, translational medicine is studied as a new style of practice where
the boundaries between the clinical and the experimental are blurred and
reconfigured. Technomimicry, in both its clinical and experimental ac-
ceptation, is the core notion that enables the identification of this novel,
emergent style of practice, where clinical routines are shaped to produce
scientific data (through the lenses of molecularization), and laboratory
procedures are adapted for the generation of knowledge and technologies
Book Review                                                               89
usable in the clinic.
    The second axis is related to the implications of molecularization for
the role of patients. Here lies a huge contrast between how the patient-
centered approach of translational medicine is depicted in the dominant
narrative of the biomedical literature and how the patient is subjectified
in current, concrete biomedical practices. By drawing on the notions of
molecularization, clinical labor, and experimental subjectification (Rose
2007; Waldby and Cooper 2014), Crabu shows how the claims of a per-
sonalized, patient-centered medicine are instead translated into the re-
duction of the patient to her/his biological and genetic specificities, mate-
rially represented by the bio-information extracted from her/his samples
and her/his informatized medical records. Crabu stresses how the patient
is, in other words, transformed into a flow of samples and bioinfor-
mation, metabolites and biomarkers, bits and data analyzed and manipu-
lated by complex technoscientific apparatuses of calculation and inter-
vention. The translational biomedical platform transforms the living body
into elements that are manipulated, mobilized and translated into infor-
mation according to experimental, patient-oriented practices. In this way,
a striking paradox in the dominant rhetoric of translational medicine is
addressed: through molecularization, the patient-centered approach turns
into the re-inscription of bodies in terms of biological entities and bio-
information. Patients are only represented in discourses, experimental
practices, and clinical procedures but not as actors-in-the-flesh. The liter-
ature in social studies of biomedicine has largely worked on the implica-
tions of molecularization for the re-shaping of the self, individuality, per-
sonhood and the subjectification of those who are enrolled as experi-
mental subjects in contemporary biomedicine. A stronger engagement
with this literature, and a closer analysis of how patients are experiencing
their re-inscription as “separable, mobile, exchangeable and reincorpora-
ble body parts” (Rabinow 1999, 95) would have enriched the valuable
problematization of translational medicine made by Stefano Crabu. Simi-
larly, the notion of technomimicry is useful to capture the mutual and
continuous realignment of clinical and laboratory practices in translation-
al medicine, but a discussion about the existing lines of conflict between
purely clinical settings and novel translational practices would have fur-
ther improved the problematization of this emerging biomedical plat-
form.
    This book is indeed a precious contribution, well integrated in the ex-
isting literature in STS and social studies of biomedicine, and it introduc-
es the Italian readers to the scholarly problematization of the situated dis-
cursive, symbolic, and material practices characterizing the contemporary
emergent biomedical fields.

References
Brown, N. and Michael, M. (2003) A Sociology of Expectations: Retrospecting
90                                                             Tecnoscienza – 11 (1)

       Prospects and Prospecting Retrospects, in “Technology Analysis & Stra-
       tegic Management”, 15 (1), pp. 3–18.
Clarke, A.E., Mamo, L., Fosket, J., Fishman, J.R. and Shim, J.K. (2010) Biomedi-
        calization: Technoscience, Health, and Illness in the U.S., Durham, Duke
        University Press.
Keating, P. and Cambrosio, A. (2003) Biomedical Platform: Realigning the Nor-
       mal and the pathological in Late-Twentieth-Century Medicine, Cam-
       bridge, MA, MIT Press.
Rabinow, P. (1999) French DNA. Trouble in Purgatory, Chicago, Chicago Uni-
      versity Press.
Rose, N. (2007) The Politics of Life Itself. Biomedicine, Power, and Subjectivity
       in the Twenty-First Century, Princeton, NJ, Princeton University Press.
Waldby, C. and Cooper, M. (2014) Clinical Labor: Tissue, Donors and Research
      Subjects in the Global Bioeconomy, Durham, NC, Duke University Press.



                                      ***
   Silvia Gherardi
How to Conduct a Practice-based Study: Problems and Methods. 2nd
Edition, Cheltenham, Edward Elgar, 2019, pp. 295

Inti Lammi Mälardalen University

    As a renowned scholar within organization studies, Silvia Gherardi
needs little introduction. Spanning topics such as work, organizational
learning, sociomaterial practices, and more recently, affectivity, Gher-
ardi’s work is generally known for its ability to introduce and reinforce
insightful new perspectives in a timely manner. Most prominently, Gher-
ardi’s work has been influential in establishing practice-based thinking
around the same time that the notion of a ‘turn to practice’ gained trac-
tion. It is thus fitting that the latest edition of her book How to conduct a
practice-based study manages to reflect much of the range of her and her
colleagues research with specific attention to practice.
    In so far as the book covers research, it more importantly covers the
process of doing research. The book is not a standard book on methods
but one that engages with giving some idea of how phenomena can be
conceptualized in a practice-based manner and in presenting stories of
how practice-based studies are possible. Consequently, the book is not a
summary of research findings or a step-by-step guide on how research is
done. While possibly confusing at first for those who might want an easy
read on what they should be doing in research, the narrative approach
