10.6092/issn.2038-3460/17167
Contemporary biomedicine is characterized by the ever-closer connection between clinical practice and research. Laboratories become nodes of articulated networks, making it no longer possible to consider them as single entities. In light of these changes, a wide range of actors – researchers, scientific instruments, data-bases, experts in bio-informatics and bio-statistics, pharmaceutical companies, clinicians, drugs, patients, cells, ethical and regulatory issues – are involved. In this Introduction, we address why these processes represent a relevant challenge for social sciences as well.
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Assunta Viteritti
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Tecnoscienza – Italian Journal of Science & Technology Studies
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From Bench to Bed, Back and Beyond: The Four Bs of Biomedical Research
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2014-07-14
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2014-07-14
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Assunta Viteritti
2014/07/14
10.6092/issn.2038-3460/17167
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University “Sapienza” of Rome
2038-3460
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From Bench to Bed, Back and Beyond: The Four Bs of Biomedical Research
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                                                                                                                                                                                                                                           Guest Editors’ Introduction

From Bench to Bed, Back and Beyond:
The Four Bs of Biomedical Research
                                        Federico Neresini                                                                                                                                                                                  Assunta Viteritti
                                                                  University of Padua                                                                                                                                                     University “Sapienza” of Rome
	
  
	
  
                     Abstract: Contemporary biomedicine is characterized by the ever-closer
                     connection between clinical practice and research. Laboratories become
                     nodes of articulated networks, making it no longer possible to consider
                     them as single entities. In light of these changes, a wide range of actors –
                     researchers, scientific instruments, data-bases, experts in bio-informatics
                     and bio-statistics, pharmaceutical companies, clinicians, drugs, patients,
                     cells, ethical and regulatory issues – are involved. In this Introduction, we
                     address why these processes represent a relevant challenge for social
                     sciences as well.

                     Keywords: biomedicine; clinical                                                                                                                                                                                practice;   translational    research;
                     laboratory studies; networks.

                     Corresponding author: Federico Neresini, PaSTIS, University of Padova,
                     Department FISPPA, Via Cesarotti, 10-12, 35123, Padova, Italy - Email:
                     federico.neresini@unipd.it



   It might seem banal to suggest that the most recent and radical chan-
ges in biomedicine may be summed up by the increasing interconnection
between clinical practice and scientific research. From this viewpoint, the
development of translational research surely represents the most consoli-
dated example of such an evolution1.
   However, we must not forget that the ever-closer link between bench
and bed evolved within the so-called “biomedical paradigm”, whose main
	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  
1
  Translational research first became a priority at the start of the new millennium.
It has given rise to programs, research institutes and scientific journals (such as
Translational Medicine and the Journal of Translational Medicine, for example). In
Europe, it has been at the core of the Commission policy: the Horizon 2020
program grants an elevated budget (more than 6 billion Euros) to activities in this
field. For a description of the significance of TR in the biomedical field, see
Woolf 2008.
	
  
TECNOSCIENZA
Italian Journal of Science & Technology Studies
5 (1) pp. 5-10 - ISSN 2038-3460
www.tecnoscienza.net                                                                                                                                                                                                               2014
6                                                                                                                                                                                                                                  Tecnoscienza - 5 (1)

characteristics are the separation of mind and body, the prevalence of the
analytical aspect within which illness is conceived as the result of an or-
ganic lesion (whether at tissue, cell or DNA-portion level) and the exten-
sion of the hospital’s function to include systematic clinical observation
and scientific research, as well as treatment and assistance.
    “From bench to bed” is therefore the essence of a union built upon
the exaltation of the individual dimension to the detriment of the collec-
tive one, the pre-eminence accorded to the body rather than lifestyle, the
central role attributed to the hospital as a place of medical practice, and
the consequent undervaluation of general practice and healthy living
conditions (in homes, the urban territory, air and water quality, the
workplace, diet and habitual behavior – in a nutshell, lifestyle). To use a
perhaps outdated but still apt expression, medicine centered on the rela-
tionship between bed and bench places the cure center-stage, while set-
ting aside prevention2. Despite its becoming almost a commonsense
statement, we argue the need to reaffirm that contemporary biomedicine
is characterized by the ever-closer connection between clinical practice
and research.
    However, this is merely a starting point: in the first place, the socio-
logical vision highlights the fact that “from bench to bed” not only fails to
describe a tension-free relationship, but also indicates the gap between
aspiring to a highly desirable future, in which many serious illnesses will
finally find a cure, and daily organization of clinical practice and labora-
tories. Various strategies are adopted in an attempt to overcome this gap
and reinforce the connection and continuity between clinical practice and
research. Among these strategies are the cultural and political support
guaranteed by the “translational imperative” and the idea that doctors
and researchers may reciprocally benefit from the greater range of thera-
peutic resources available to the former and the funding available for re-
search activities to the latter (see the scenarios by Harrington and
Hauskeller in this special issue). Secondly, though it is now clear that the
expression “from bench to bed” must be completed by adding “and
back”, many contributions received from Science & Technology Studies
(STS), among which also those proposed in this special issue, have high-
lighted the necessity of further widening the scope to include a heteroge-
neous and articulated group of actors. Therefore, four “Bs” are to be con-
sidered: from Bench to Bed and Back, and Beyond.
    The network of actors involved in the relationship between clinical
practice and research does not merely include patients and their relatives,
	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  
2
   As we know, first-level prevention deals with environmental conditions and
lifestyles, while the second level may be considered as “early diagnosis”, i.e. an
action perspective fully embraced by the biomedical paradigm. Indeed, “early
diagnosis” highlights one of the contradictions arising when the discovery of a
potential or initial pathological state fails to correspond to a real possibility of
therapeutic intervention.
Neresini and Viteritti                                                     7
but also the State, pharmaceutical companies, scientific instruments, data
and tissue banks, as well as more traditional characters (such as laborato-
ry technicians and medical staff) and new experts (such as bio-
statisticians and bio-informaticians), together with experimental protocols
and diseases. The list then comprises citizens’ and patients’ associations,
which are more and more involved not only in funding research, but also
in defining aims and orienting research activities (Callon and Rabeharisoa
2008; Epstein 1996). Thus, what first appeared to be restricted to only
two groups of players, doctors and researchers, has rapidly become an is-
sue that involves a growing number of heterogeneous elements moving
within temporal and spatial regions in which global visions and local ma-
teriality interact (Law and Mol 2001; Law and Singleton 2003).
    One of the emerging problems regards the statute and form of such
networks: are they cluster or collective, platform or vector, merely the
product of interaction among the involved actors or also the result of STS
scholars’ selection and pre-comprehension processes aimed at extracting,
analyzing and representing data? In any case, as it also emerges from the
contributions in this special issue, they are hybrid social spheres where el-
ements become mediators and interact and produce a multiplicity of bio-
objects (Webster 2012), such as the “triangle DNA origami” studied by
Crabu or the umbilical cord, as shown by Beltrame. Notable among the
artifacts emerging within these networks are the information infrastruc-
tures (Star and Bowker 2002; Mongili and Pellegrino, forthcoming) which
produce, elaborate and make available ever more abundant and multi-
form data: genetic sequences, publications, cell lines and tissues. On the
other hand, while clearly not all which is deemed “translational research”
deserves this definition strictu sensu, the opposite is also true: much of
what happens outside this definition actually moves within the perspec-
tive of an ever-closer interconnection between clinical practice and re-
search, as the contributions by Beltrame and Turrini show.
    Together, these changes pose new questions and at the same time re-
formulate traditional ones, in the attempt not only to understand what
bio-medicine is becoming, but also to rethink STS aims and methods.
The opening contribution by Cambrosio, Bourret, Rabeharisoa and Cal-
lon proposes a deep and sophisticated reflection on this topic. Starting
from the results of recent studies on evolution in biomedical research, the
authors open a debate on how STS analyze such transformations, espe-
cially when adopting tools originally developed for handling the large
amounts of data produced in the biomedical research field itself. In this
way, STS are linked to a wider debate involving sociology as a discipline
which addresses social phenomena departing from the Big Data perspec-
tive and by adopting “digital methods” (Rogers 2013) – including visuali-
zation tools. Here one of the critical issues is the degree of awareness so-
ciologists may have of the agency of such tools and algorithms, as well as
the reliability and accountability of the latter. Cambrosio and colleagues’
proposal to see them as “dynamic experimental tools instead of tools for
8                                                             Tecnoscienza - 5 (1)

having/representing static results” is thus of particular interest. Above all,
it suggests not to analyze the evolution of networks starting from a stable,
pre-determined group of actors, but rather to highlight the emergence of
a progressive configuration of collectives made up of human and non-
human actors, whose interaction makes the agency of each component
reciprocally possible.
     Therefore, a dynamic analysis of networks should not only mean ob-
serving how configurations of actors’ relationships in the same cluster
change over time, but also what kind of new actors enter the scene, and
which former actors leave it. Both the contributions by Nadine Levine
and Conor Douglas reflect on this relationship between Big Data and in-
terpretative processes in translational research.
     In Levine’s contribution, the diverse concepts researchers and doctors
refer to in translational research are explored through an ethnographic
investigation in a laboratory working on the development of molecular
markers in post genomic studies on metabolism. Due to the ways in
which objects, illnesses and data are interpreted, we see the emergence of
tensions generated by the interaction of researchers and clinicians. Trans-
lational research is therefore a complex and dynamic process, character-
ized by margins of uncertainty and the hard work involved in transform-
ing this density of data into a greater understanding of illness.
     Douglas’s contribution too looks at the possibility of translating huge
research based data into clinical practice. The case study refers to a vast
Canadian scientific network within which two bio-informatics tools – a
database (InnateDB) and a suite of analytical visualization tools (Cere-
bral) – have been developed. Both tools are the result of developers’ work
on an open source/open access basis in close contact with users in the
clinical field.
     In various ways and from different perspectives, the contributions in
this issue also deal with the theme of standardization as a mix of strategies
and combinations, with the scope of aligning the diverse actors involved
in the setting up and development of a network. This is what happens in
the cases illustrated by Turrini and Beltrame.
     Turrini’s contribution analyzes how new pre-natal diagnostic technol-
ogies are trying to gain a foothold, causing tension in diverse professional
traditions and epistemologies. In particular, conflict emerge when an ap-
proach based on molecular biomedicine is proposed as a basis for stand-
ardization and thus the possible engineering of pre-natal diagnostics, a
field still largely dependent on the artful sight of those who observe the
chromosomes in order to identify possible anomalies in cytogenetic analy-
sis laboratories.
     Beltrame’s article, on the other hand, illustrates the complex process
through which human waste tissue (such as the umbilical cord) can be
transformed into an object of study and innovation in biomedical re-
search. The process of bio-objectification involving this human tissue al-
lows us to observe the interactions between biological research and clini-
Neresini and Viteritti                                                                                                                                                                                                             9
cal practice in the development of therapeutic applications for umbilical
cord cells, while also highlighting how the emergence of a new class of ac-
tors, the bio-banks, produces diverse processes of bio-objectification and
economic regimes for their exploitation. The bio-banks have become a
hub of particular interest in analyzing the divergent articulations linking
biomedicine and society, underlining the tensions which emerge when
these actors enter into direct contact with the subjective dimension of so-
cial life.
    Finally, Crabu’s article and the conversation among Burri, Carusi and
Aspradaki introduce and examine in depth two further elements which
assume particular importance, to both understand the processes connect-
ing heterogeneous actors in biomedical research collectives and analyze
their transformations.
    According to Crabu the promising scenarios presented by nanomedi-
cine, similarly to what happens in translational research, act as connectors
among actors with diverse aims and motivations, on the condition that
such a promise might evolve into something concrete, such as in the case
of the bio-object denominated “triangle DNA origami”. The creation of a
nanomedical laboratory, in which research for development of this new
nanodevice is carried out, offers the opportunity of observing how this
promissory bio-object becomes the terrain for a meeting between the an-
ticipatory narrative level and the materiality of scientific activity.
    While raising a series of ethical, economic and legal issues linked to
the use of diagnostic images in and around the relationships between clin-
ics and laboratories, Burri, Carusi e Aspradaki clearly show such images
are capable of acting as a catalyst among researchers, doctors and pa-
tients. At the same time, it is clear that the information overload pro-
duced by the flow of Big Data also manifests itself in the form of a huge
amount of diagnostic images generated by sophisticated and black boxed
apparatuses anything but intelligible and unambiguous3.
    At this stage, it appears clear that both translational and biomedical
research move far beyond the laboratory. Laboratories have become
nodes of articulated networks, making it no longer possible to consider
them as single entities. In light of these changes, a wide range of actors –
researchers, scientific instruments, data-bases, experts in bio-informatics
and bio-statistics, pharmaceutical companies, clinicians, drugs, patients,
cells, ethical and regulatory issues – are involved. Rather than pointing to
the end of Laboratory Studies, this awareness promotes their revival. The
laboratory becomes one of many actors interacting within a heterogene-
ous field, giving life to a dynamic network which challenges our possibili-
ties of comprehension, the research tools we use and the theoretical hy-
potheses we depart from.


	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  
3
       For a review, see Perrotta 2012.
10                                                                 Tecnoscienza - 5 (1)


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