10.6092/issn.2038-3460/17216
application/pdf
2038-3460
17216
2
en
Stefano Crabu
https://creativecommons.org/licenses/by-nc-sa/2.5/
Tecnoscienza – Italian Journal of Science & Technology Studies
Peter Keating and Alberto Cambrosio, Cancer on Trial. Oncology as a New Style of Practice, The University of Chicago Press, 2012
Text.Serial.Journal
https://tecnoscienza.unibo.it/
5
Book Reviews
2015-01-29
2023-06-14
2015-01-29
2023-07-27
98-103
TS
Stefano Crabu
2014
10.6092/issn.2038-3460/17216
98
University of Padova
2038-3460
2
en
103
Peter Keating and Alberto Cambrosio, Cancer on Trial. Oncology as a New Style of Practice, The University of Chicago Press, 2012
https://tecnoscienza.unibo.it/article/download/17216/16095
5
98                                                            Tecnoscienza – 5 (2)

models but on different argumentations that people mobilize in their ex-
perience of time.
    In the fourth part, studies give account of the fact that the technologi-
cal risk has not replaced the social risk. In the analysis of the trajectory of
tuberculosis, the phenomenon of resistance to antibiotics is not qualified
as “iatrogene” by health institutions but it is connected to a misuse of the
technology by users and to problematic social contexts. In another exam-
ple, which compares two experiences of epidemiological crisis in XVIII
century and at our time, the human conditions seem to be at the base of
the epidemics, beyond any rational technical tool of risk management.
Finally, climate change represents the greatest challenge to the notion of
risk and to the research in social science. Its exceptional character con-
sists in its planetary dimension, it irreversibility and its close link to gov-
ernance questions.
    Even though some of the argumentations mobilized in this text are
not completely new and despite a certain difficulty in finding a file rouge
among all the texts, the readers of Tecnoscienza may appreciate the poly-
semy of contributions stemming from different disciplinary approaches.
Beyond all criticisms and attempt to overcome the notion of risk society,
the expression introduced by Beck still represents one of the grand récit
of our time and this book provides a further confirmation of it. At the
same time, this contribution speaks for the difficulty of finding a new co-
herent grand récit, under the banner of “threat”, “catastrophe” or some-
thing else.


                                     ***


     Peter Keating and Alberto Cambrosio
Cancer on Trial. Oncology as a New Style of Practice
Chicago and London: The University of Chicago Press, 2012, pp.
456

Stefano Crabu University of Padova

    What do prizes donated by General Motors, oncomice, molecules, pa-
tients, the acronym VAMP, statisticians and oncology have in common?
Apparently very little. They are, however, some of the elements and ob-
jects that, throughout a complex and articulated convergence process,
laid the foundations for the birth of the composite and diverse biomedical
transnational movement for cancer research and treatment.
    The history of this particular and heterogeneous convergence is the
subject of the latest book by Alberto Cambrosio and Peter Keating, two
of the most eclectic and prolific authors who have worked at the inter-
Book Review                                                                99
stice of history and social studies of science and technology. Without ever
giving in to the illusion of producing a teleological narrative that sub-
sumes, as in a “total history”, the emergence and development of scien-
tific research in oncology, the authors describe, in a detailed and meticu-
lous way, the genealogy – in the sense conferred by Foucault (1963) – of a
portion of contemporary biomedicine that has significantly contributed to
innovate and transform biomedical practice tout court.
     Through a narrative comprising 12 dense chapters divided into 3 dif-
ferent sections, the volume offers an interpretation of the practices, the
economic, institutional, organisational, epistemological and technological
dimensions, and the political implications of scientific research in support
of cancer care and treatment. These are dimensions that give depth to the
analysis of the pillar, now taken for granted, of contemporary oncology
practice: cancer clinical trials, which the authors define in terms of a new
“style of practice”.
     This latter concept is discussed in the introductory chapter of the text
and is inspired by a well-known article published in 2007 in the Bulletin
of the History of Medicine by the authors themselves (Keating, Cambrosio
2007). In this sense, the introductory consideration to the volume consti-
tutes the theoretical framework of the empirical analysis that runs
through a plot which is densely populated by human and animal actors,
biological entities, technical objects and epistemological assumptions.
     The authors, approaching the tradition of social studies on science
and technology, take up the classic concept of style of reasoning in an in-
novative way. Proposed by Ian Hacking in the early '90s, the notion of
style of reasoning (1992a; 1992b) indicates a particular configuration of
institutions and organisations in relation to scientific practices and tech-
nologies aimed at investigating specific research questions, elaborating
convincing answers, evaluating and disseminating the results to the scien-
tific community, and regulating research activities. In reference to the
thought of Hacking, however, Cambrosio and Keating suggest a semantic
shift by proposing the term style of practice, in order to clear the notion of
style of reasoning from its particular “cognitive” connotation. Further-
more, while Hacking's analytical perspective has a long-term historical
reference, the volume proposed by Cambrosio and Keating seeks to ex-
plore the processes of innovation in the biomedical field through a few
decades.
     Each of the three sections making up the text explores in great detail
the three historical moments identified by the authors, through which the
methodology of conducting cancer clinical trials has emerged, developed
and partially stabilised as the new style of practice in the biomedical dis-
ciplinary domain. Although the boundaries between the three main his-
torical periods when this new style of practice was developed are relative-
ly unclear, the authors identify peculiar elements of discontinuity that al-
low a precise and clear characterisation.
     The first historical phase (chapters II-V), which evolved from the mid-
100                                                         Tecnoscienza – 5 (2)

50s to the mid-60s of the last century, saw the emergence of chemothera-
py as a potential third treatment course for the cure of cancer, in addition
to surgery and radiotherapy. 1955 is perhaps to be considered as a land-
mark year for cancer research, which in previous decades was rather
characterised by a “scientific Tower of Babel” where simple qualitative
observations wouldn't go beyond medical anecdotes. In this first part of
the text, the authors thoroughly analyse the emergence and development
of chemotherapy practice, medical oncology and clinical experiments in-
corporated in clinical trials. This first phase is marked by what Cambrosio
and Keating define as the experimental turn that led to the emergence of
a new style of practice generated by chemotherapy, which would soon
involve all aspects of cancer treatment and care (radiotherapy, chemo-
therapy and surgery).
    While avoiding the banal empiricism that regards clinical research as a
mechanism of linear implementation of “objective” laboratory results, the
authors take into account two important experimental protocols (so-
called VAMP and 6313 protocols) in order to show how, since the mid-
50s, a new and completely unique style of research has emerged. This is
based on a highly experimental design that lays its roots in biostatistics,
careful selection of patients and treatment procedures, and unequivocal
criteria of correlation between variables. In this sense, VAMP and 6313
protocols offer a privileged analytical perspective on the complex institu-
tional and cooperative network that allowed the emergence and imple-
mentation of clinical trials. In the first section of the book, the authors
emphasise the cooperative nature that marked the beginnings of clinical
research in oncology. As a result, Cambrosio and Keating coined the term
“epistemic organisations” in order to stress the importance of integrating
experimental and clinical research and the organisational methods devel-
oped in support of the research itself. It is a fact that, despite the great
interest among historians and sociologists in the subject of oncological
trials, only few studies mentioned the key role of cooperation. Historians
mainly based their work on archives and investigated institutions such as
hospitals, professional associations or commercial enterprises that pro-
duced and filed such records. Furthermore, the distributed/fragmentary,
flexible and provisional nature of the cooperative activity of cancer
groups and the lack of records that testify its importance, led social sci-
ences as a whole to overlook this specific method of carrying out scientific
investigation. As a matter of fact, in the attempt of establishing a strong
link between science and industry and self-verifying the sterile paradigm
where “science discovers” and “industry applies”, social sciences have
traditionally seen chemotherapy and cancer research as the outcome of a
well-defined industry research program. However, the first part of the
volume shows how cooperative groups from both sides of the Atlantic
were particularly differentiated and quite far from the organisation of in-
dustry research as it was conceived, for example, in the making of the
atomic bomb.
Book Review                                                                 101
    The second section of the book (chapters VI-IX) is dedicated to the
analysis of the development processes taking place from the mid-60s
through the 80s that involved some of the most significant institutions
arising from the birth and stabilisation of cooperative groups – such as
ECOG (Eastern Cooperative Oncology Group) or EORTC (European
Organisation for Research and Treatment of Cancer) – as protagonists of
cancer research in the previous decades. This second historical stage is
dominated by large-scale clinical trials having the objective of comparing
the potential of new therapeutic regimens based on the combination of
several pharmacological substances, and recursively problematising neo-
plastic diseases against which these regimens were designed. These trials
shared the fractional efficacy of chemotherapeutic drugs to hinder the
replication of cancer cells (the cell kill hypothesis) along with a number of
assumptions about the growth and replication of cancer cells (cell kinet-
ics).
    Accordingly, the authors focus on how the design and experimental
implementation of the clinical trials discussed in the first part of the vol-
ume have changed. Cambrosio and Keating describe the transition from a
first phase, mainly characterised by clinical screening of anti-tumour sub-
stances being tested on a relatively small number of patients, towards
clinical research on a very large scale. Although the clinical protocol ana-
lysed in this section (ECOG 0971) differs from the previous protocol
(VAMP), it cannot be considered as a novelty in itself, since it took over
and showed standard features of the new practice style that had already
emerged in the previous phase. This new phase, whose importance is
symbolically expressed by the ECOG 0971 protocol, is seen as part of a
broader research strategy based on the alignment of a number of related
institutions within a transnational network, including data centres and
protocol review committees that helped streamline the work of coopera-
tive groups. In addition to these innovations, there is the development of
new strategies for statistical analysis (sequential statistics, centralised ran-
domisation) in support of experimental design and analysis of data pro-
duced by cancer clinical trials. This contributed to the development of a
complex distributed network involving a range of different professionals,
such as doctors, data managers and biostatisticians, who gave the impulse
to further strengthen the emerging evidence from clinical research with
the aim of reshaping anticancer therapeutic practices. Keating and Cam-
brosio describe the development of a clinico-experimental network going
beyond the rigid institutional and national borders and establishing a new
biomedical space where oncologists and biological entities cooperate
within the framework established by the new style of practice. The au-
thors show how the methods of cooperation and partnership involving
researchers from both sides of the Atlantic has become extremely com-
plex and varied through the incorporation of an increasing number of
stakeholders, including, for example, the pharmaceutical industry. This
led to the emergence of new organisational processes subjected to the
102                                                         Tecnoscienza – 5 (2)

production of scientific knowledge in oncology and constituting what has
been called oncopolitics, described as the method for governing the pro-
cesses of production and sharing of knowledge about cancer(s).
    During the 80s, however, a sense of crisis pervaded the international
community of oncologists. Some of them even argued that cancer re-
search had come to a plateau and no trial could significantly increase the
chances of curing and treating cancer. The end of the 80s, with the so-
called molecular turn, marks the beginning of the third historical phase,
which is dealt with in the last part of the volume (chapters X-XII). The
authors show how the innovations in the field of molecular biology rein-
vigorated cancer research, transforming the epistemological assumptions
and the management of experimental practices. In 1984 the first human
oncogene was isolated and, at the same time, that complex and controver-
sial process that would then lead to the sequencing of the entire human
genome began (M’charek 2005). These are the elements peculiar of the
third phase identified by the authors of the book, which is characterised
by the hybridisation of different disciplines for the consolidation of onco-
genic theory within the study, prevention and treatment of cancer. In par-
ticular, clinical research would no longer focus, as was the case in previ-
ous decades, on strategies for the prevention of cancer cells replication.
The episteme passes from a cellular level to a sub-cellular one, in order to
develop new therapeutic regimens capable of interfering with the bio-
chemical processes that take place in sub-cellular interactions. Therefore,
the hybridisation between cancer clinical trials and molecular biology
gave rise to the idea that the ever-increasing gap between basic and clini-
cal research could be further reduced. Under the aegis of what was de-
fined as translational research in biomedical circles, a number of research-
es and new funding programs had reinstated the rhetoric of the so-called
“unity between care and clinical research”, expressed by the all-
embracing concept of biomedicine (Clarke et al. 2010). Therefore, the
consolidation of the oncogenetic theory opens the doors to new research
strategies and new ways of treating cancer patients. Biomedical strategies
regard translational research and targeted therapies as the two most inter-
esting approaches so far available and encourage the redefinition of the
new style of practice, in order to achieve a greater synergy between re-
search laboratories and the clinical domain.
    Overall, the work of Cambrosio and Keating is difficult to categorise
with a specific disciplinary label. The book is mainly a work of history of
science that also examines the processes of innovation in the biomedical
field from a distinctively sociological perspective. Of particular interest
for STS researchers is that both the historical and sociological perspec-
tives are fully involved in the narrative and provide theoretical thickness
to a work with a strong empirical structure, which is based not only on
the traditional archive sources generally accessed by historians, but also
on biomedical literature, interviews to leading names in the field, as well
as an interesting and innovative bibliometric analysis of scientific produc-
Book Review                                                             103
tion. For this reason, this book shows a renewed methodological option
that STS should take into careful consideration: the genealogical perspec-
tive.
     While contemplating a genealogical approach and a particular sensi-
tivity to the social dimensions of science and technology, this book also
stresses the importance of complementing a processual and contingent
analysis of the production and sharing of scientific knowledge (typical of
ethnographies) with a diachronic dimension. This would allow to account
in an articulated way for the historical dimension of how different geneal-
ogies of actants converge, diverge and rearrange, creating a technoscien-
tific balance, as precarious as it may be.

References
Clarke, A. E., Mamo, L., Fishman, J. R., Shim, J. K. and Fosket, J. R. (ed.)
      (2010) Biomedicalization. Technoscience, Health, and Illness in the
      U.S., Durham, NC, Duke University Press.
Foucault, M. (1963) Naissance de la clinique. Une archéologie du regard
      medical, Paris, Presses Universitaires de France.
Hacking, I. (1992a) The Self-Vindication of the Laboratory Sciences, in A.
      Pickering (eds.) Science as Practice and Culture, Chicago, The Uni-
      versity of Chicago Press, pp. 29-64.
Hacking, I. (1992b) Statistical Language, Statistical Truth, and Statistical
      Reason: The Self-Authentication of a Style of Scientific Reasoning, in
      E. McMullin (ed.) The Social Dimension of Science, Notre Dame,
      University of Notre Dame Press, pp. 130-157.
Keating, P. and Cambrosio, A. (2007) Cancer Clinical Trials: The Emer-
      gence and Development of a New Style of Practice, in “Bulletin of
      the History of Medicine”, 81 (1), pp. 197-223.
M’charek, A. (2005) The Human Genome Diversity Project: An Ethnogra-
      phy of Scientific Practice, Cambridge, Cambridge University Press.



                                   ***


    Tom Boellstorff, Bonnie Nardi, Celia Pearce and T.L.
    Taylor
Ethnography and Virtual Worlds: A Handbook of Method
Princeton and Oxford: Princeton University Press, 2012, pp. 237

Giacomo Poderi University of Trento
