Stefano Crabu
Exploring the constitution of biomedicine through
the lens of science and technology studies. From
local ethnographies to computational sociology and
back. A dialogue with Alberto Cambrosio
(doi: 10.1423/100626)
Rassegna Italiana di Sociologia (ISSN 0486-0349)
Fascicolo 1, gennaio-marzo 2021
Ente di afferenza:
Universit`a di Padova (unipd)
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RASSEGNA ITALIANA DI SOCIOLOGIA / a. LXII, n. 1, gennaio-marzo 2021
Exploring the constitution of biomedicine through
the lens of science and technology studies
From local ethnographies to computational sociology
and back
A dialogue with Alberto Cambrosio
by Stefano Crabu
The study of medicine and the health professions has long played a role in pollinating the general sociology debate and social theory at large (Rose 2007). It is broadly recognised that medicine and clinical settings allow for extensive fieldwork concerning some of the most fundamental pillars on which the «sociological imagination» rests, the most relevant of which are the legal institutionalisation of power and professional authority, trust as a condition for the reproduction of the social order and processes of social control and deviance. In this way, traditional medical sociologists have undoubtedly offered relevant conceptual frameworks to understand how agencies of social control work, how they orient the construction of the cultural authority and the moral force of so-called «expert professions». Although this body of research well explored the reciprocity between medical expertise, cultural processes and power relations, it fundamentally neglected to pay attention to the scientific and technological (i.e. material) dimension, in which the everyday work of health professionals is deeply embedded. For example, if we look at oncology (one of the most relevant domains of medical expertise in the last 50 years), it is clear that this field resides within large heterogeneous networks. Such networks encompass transnational research institutions, funding programs to support them, legisla-tive frameworks and the factors and conditions shaping specific (bio)technologies (e.g. imaging techniques, genome sequencing technology and algorithms) and socio-technical infrastructures (e.g. information systems for the management of digital health records, online genetic databases). These networks are able to configure durable and stable relations over time and space between diverse medical practitioners, researchers and patients. Despite
the clear and compelling empirical pervasiveness of science and technology (or technoscience; see Latour 1987) within medical domains, it is worth noting that traditional medical sociologists acted as uncompromising «guarantors» of sociological immunity, which, for a long time, protected scientific and medical knowledge from scrutiny by social scientists (Richards 1988; Bartley 1990).
The interdisciplinary field of science and technology studies (STS) has been influential for reorienting sociological interest toward understanding how scientific and technological develop-ments can co-define the conceptions of health, illness, human identity and governance, and how they reshape the political, cultural, economic and legal landscapes (Burri, Dumit 2007). It is within this broad perspective that we can locate and fully capture the scientific and intellectual trajectory of Alberto Cam-brosio, Professor and former Chair of the Department of Social Studies of Medicine at McGill University. Over the past thirty years, Cambrosio has greatly contributed to rethinking the ways in which social scientists can produce thorough accounts of contemporary biomedicine, emerging at the interface of clinical settings, laboratories, biotechnology, and the pharmaceutical in-dustry. Thus, this interview is an attempt to dialogically describe some conceptual and methodological «upheavals» that were trig-gered by Cambrosio and colleagues’ fieldwork and were widely propagated within social studies of biomedicine as well as in the broader fields of science studies and sociology.
One of the main legacies of STS, which strongly influenced Cambrosio’s work, is a theoretical apparatus aimed at understanding the mutual relationships between political and social institutions and the micro process of manufacturing scientific and medical knowledge. In more detail, within mainstream medical sociology, it is generally accepted that scientific facts exist independently of the practitioners who discover and formalize them. This issue is viewed completely differently by STS scholars; they point out that what is at stake in the scientific enterprise is not so much discovering facts that should pre-exist in nature, but translating local evidence into generally accepted scientific facts. In other words, the STS perspective is about explaining why, how and
through which social arrangements the findings generated by a
specific experimenter in a peculiar experimental setting (e.g. a laboratory or computational simulation environment) at a particular time can become a universally accepted fact. It is the process of
knowledge scaling (i.e. codifying knowledge to transfer it from a local to a global scale) that has attracted the primigenial interest of STS scholars. That is, there was increased attention to the processes – grounded in scientific standards, technical equipment, rules and conventions – through which local scientific evidence is rendered actionable within other, diverse contexts. Accordingly, STS focuses on how local evidence could be freed from its signs and peculiarities of origin and then naturalized into transferable scientific claims that can be enacted in other contexts and ex-perimental settings. Within mainstream medical sociology, the way to address this issue is obvious: medical facts are recognized as universal because they are inherently true, since the underlying scientific methods and procedures have the power to mirror reality. STS scholars address this topic in a quite different way: a fact is considered to be true by a concerned scientific com-munity because it has gained a universal character by means of consistent mobilization and alignment of cognitive, material and social elements. Scientific claims, therefore, do not exist outside the hybrid networks (of technical and information infrastructures, scientific papers, statistics, rules, scientific tools and so on) that underlie them. When a biomedical fact seems to be universally «indisputable», it means that these networks are successfully spreading globally through the sharing of rules, conventions and standards among scientific communities (see Latour 1987). Even the most fundamental research methods that sustain biomedical endeavors, such as experimental protocols, epidemiological models and ways of collecting quantitative data, must be understood as a process of negotiation occurring within a specific social, geo-political, historical and explanatory context. The current scientific controversies about how to predict the spreading of Sars-CoV-2 are striking empirical proof of this key issue.
Alberto Cambrosio represents one of the most prominent voices boosting within social theory the analytical sensitivity cultivated by STS. The fil rouge that connects his ample research work is multi-method investigation of how biomedical practices – especially those driven by molecular biology and (post-)genomic develop-ments – emerge at the nexus between clinical care and research settings. In so doing, he has been able to capture the complex dynamics of the establishment of hybrid networks connecting experts from various domains (e.g. pathologists, physicians, com-putational biologists, molecular biologists), medical technologies
and other evidential resources (e.g. genomic databases, clinical trial results) from which everyday therapeutic options emerge. At the risk of simplification, if we should find a milestone within Cambrosio’s impressive published work, we can identify it as the book he co-authored with the historian Peter Keating,
Biomedi-cal platforms. Realigning the normal and the pathologiBiomedi-cal in late-twentieth-century medicine (2003), which was awarded the Ludwik
Fleck Prize by the Society for the Social Studies of Science in 20051. In this book, we find a powerful conceptual scaffold for
reading the processes of mutual entanglement between bio-medical entities (e.g. cells, genes), techniques and instruments for their visualization and manipulation, and standards and rules for the development of scientific and medical innovations in post-World War biomedicine. Theoretically speaking, as will be clarified by Cambrosio in the course of this dialogue, the empirical investi-gations that coalesced in the aforementioned book relied on a strong theoretical frame that combined Georges Canguilhem’s philosophy of science with Gaston Bachelard’s (1984) «phenom-enotechnique». If we carefully consider the analytical power of the phenomenotechnique, according to which «it may well be the instruments that produce the phenomenon in the first place» and «instruments are nothing but theories materialised» (Bachelard 1984, 13), we can easily understand the relevance of bringing materiality back to the centre of understanding biomedicine, as Keating and Cambrosio nicely did.
In continuity with the «biomedical platforms» research initia-tive, Cambrosio’s most recent book, Cancer on trial. Oncology as
a new style of practice (co-authored with Peter Keating, 2012),
offers a unique historical account of some of the major pillars of contemporary biomedicine by investigating the constitution of cancer research and clinical trials. Here, biomedicine is framed not merely as a locus for applying stabilized knowledge when caring for patients, but as a site for developing clinically action-able knowledge and an experimental setting that leads to the shaping of fresh knowledge on disease, disease staging and the definition of nosological categories. Overall, the mentioned research monographs have, over time, given birth to several conceptual spin-offs. Such spin-offs, which will be discussed in the course 1 The Fleck Prize is an annual award given to an outstanding book in the area
of this dialogue, allow us to consider how the boundaries be-tween research and care are fading in contemporary biomedical technoscience, leading to emerging forms of «experimental care» (see Cambrosio et al. 2018). This process of entanglement be-tween research and care expertise mainly occurs within large‐scale collaborative biomedical projects, which, as will be pointed out in the final lines of this conversation, Cambrosio and colleagues explored through the combined adoption of ethnographic observa-tions within organisational settings and other research techniques, such as scientometric and computational sociology techniques. This is one of the major methodological achievements promoted by Cambrosio and colleagues, which innovatively exploited the spreading of online databases of scientific publications (e.g., Web of Science, Scopus, and PubMed) as critical sources of informa-tion on biomedical work.
More generally, we should recognize that, today, sociology and social science at large are still «balkanized» into quanti-tative and qualiquanti-tative «research gangs», which have particular research objects and ways of knowing society. Accordingly, (we) scholars rhetorically defend (our) their strongholds by postulat-ing the incommensurability between approaches, ontologies and epistemologies. Luckily, as Alberto Cambrosio will point out in the closing remarks of this dialogue, it is becoming increasingly
a la page to refuse and overcome the «methodological divide»
between the «quali/quanti» factions, boosting the heuristic po-tentiality of mixed-method approaches and sweeping away this useless epistemic and ontological «gang war».
To close these introductory thoughts, Cambrosio’s intellec-tual trajectory, although built in the context of the STS, could be extended to re-encode stabilized sociological theories. Thus, it elicits sociologists to continuously reconsider and question conceptual and methodological tools – or, more specifically, to break disciplinary boundaries and exit from the interpretative comfort zone. This clearly implies a breach of taken-for-granted theoretical and epistemological assumptions to overcome the risk of adopting analytical schemes that, based on precedents, are not able to grasp the challenges that contemporary socio-technical landscapes pose to social scientists.
Stefano Crabu: First of all, I would like to thank you for this
opportunity to talk with you about your intellectual trajectory. I’m primarily interested in understanding how, in the early 90s, you entered the field of social studies of biomedicine by adopting a science studies perspective. I know that after obtaining a Bachelor’s in Zoology, you got a Master’s in Environmental Sciences. You then radically changed your field of study. Indeed, in the mid-80s you completed your Ph.D. in the History and Sociology of Science at the University of Montreal.
Alberto Cambrosio: I have always been attracted to the social
sciences, but when I entered university I decided to study biology. I was fascinated by molecular biology and, back then, I felt – and I apologize in advance for this statement, which might offend some of my colleagues – that while I could continue learning about the social sciences on my own, mastering an «esoteric» topic such as the natural sciences required a passage through the research laboratory that could only be pursued by following an academic course. I don’t regret this choice, as it was very useful when I later changed direction to undertake a doctorate in the sociology of science. There are obvious reasons for this, including learning about scientific practices «from within», but there is more. Indeed, when I decided to enrol in biology at the University of Basel at the end of the 1960s, I discovered that such a degree did not exist: you had to opt for a degree in zoology or botany, and in both cases, to my great surprise, those two fields were taught in a very traditional way: comparative morphology rather than molecular biology. This soon changed when the university – relying on the presence in Basel of mul-tinational pharmaceutical companies – built the «Biozentrum»2:
a research centre at the cutting edge of molecular biology, at-tracting teams of international calibre from, among others, the University of Geneva. Suddenly, the 20th century had arrived, not
only in terms of scientific themes and topics, but also in terms of the organisation of research. This was not without provoking negative reactions, which I witnessed, from traditionalist zoology professors who were offended, for instance, by the importation of what they perceived as North American «barbaric» practices 2 For a thorough historical account over the establishment of the Biozentrum see
such as lunchtime seminars. At about the same time and in the same city, Hoffman-La-Roche established the Basel Institute of Immunology, which would soon also become an international reference point. I was able to get to know researchers from these two centres and observe in real time, without really realizing it at the time, an almost epochal transition between two «styles of practice» (see Keating, Cambrosio 2012) or, to use John Pick-stone’s (1993) expression, two «ways of knowing». One could say, retrospectively, that this made me aware of the historicity and the socio-technical dimensions of scientific practices, and it might explain, at least in part, my decision to change course when the opportunity arose. Having obtained a scholarship to pursue a doctorate in Canada, I discovered the existence at the University of Montreal of a recently established Institute for the History and Socio-politics of Science (IHSPS) that allowed stu-dents with a scientific background to pursue advanced degrees in social studies of science and technology. This was the time of the emergence of the new sociology of science or, rather, of the interdisciplinary domain known as Science and Technology Studies (STS). In addition to opening up the content of techno-scientific activities to sociological analysis, STS (or at least some strands of it) sought to renew, reflexively, the social sciences themselves. The IHSPS was a privileged environment to follow this process, thanks to its faculty straddling North America and Europe, complemented by regular faculty exchanges with Johns Hopkins University and the University of Strasbourg, and seminars offered by many prestigious guests. Right away, I was able to attend several lectures by Thomas Kuhn and follow a doctoral seminar with Joseph Ben-David who taught me a lot even though I disagreed with his structural-functionalist approach. Most of the central figures of STS visited the IHSPS, including Michel Callon, with whom I subsequently maintained regular contact during frequent visits to Paris; and Bruno Latour, who had just published with Steve Woolgar (1979) the book Laboratory life and who also introduced me to the symbolic interactionist stream of STS, primarily developed by Susan Leigh Star, Joan Fujimura, Elihu Gerson, and Adele Clarke. Perhaps to mark a break with my previous trajectory, I nevertheless decided to write a thesis on a «social» topic in the more traditional sense, namely an analysis of the critical science movement and the unionization of researchers in Italy. While completing my thesis, however, my
interest quickly returned to the analysis of biological practices, a trend that was reinforced during my post-doctoral studies at the Massachusetts Institute of Technology, where I was able to investigate the work of biologists at the cutting edge of their field while being affiliated with MIT’s STS program.
SC: The epochal transition you just highlighted in regard to
the Biozentrum seems to have deep ramifications for the current forms of organizing and doing scientific research in life sciences and beyond, where the boundaries between academia, industry and the market are particularly weak…
AC: Indeed, one could argue that the transition I observed
was a bellwether of things to come. The Biozentrum was built by the University of Basel with financial support from the Cantonal government and local pharma companies. It promoted a new interdisciplinary approach to the life sciences that was relatively unique in Europe at the time. And, sociologically speaking, it was a very interesting place: a floor of the Biozentrum build-ing housed pharma research laboratories while the other floors were occupied by leading academic researchers (including a future Nobel laureate). The connection between academia and industry was built into the architecture of the Biozentrum and promoted seamless relations and mutual cross-fertilization by its very socio-materiality. As for the Basel Institute for Immunology, while entirely financed by Hoffman-La-Roche and thus a private institution, it was nonetheless organized like an academic research centre. I remember visiting this institute and being impressed by an overflow of equipment: there were scientific instruments everywhere, even in the corridors to the point that you could hardly walk. While, today, pharma-bashing and the denunciation of conflicts of interest have become commonplace, back then the entanglement between public and private initiatives was not seen as an issue, this was simply how things were done in the emerging domain of the molecular life sciences.
SC: We may say that, during the 70s, you had the chance to
directly observe a period characterized by growing financial and infrastructure investments in the life sciences. Especially from the early 90s, this issue attracted the attention of many STS scholars. Indeed, when you started your academic career within the
Depart-ment of Social Studies of Medicine (SSoM) at McGill University, the mainstream field of medical sociology had begun to face challenges by STS-oriented scholars. We can find a trace of this momentum within the excellent book you edited with Margaret Lock and Alan Young, Living and working with the new
medi-cal technologies. Intersections of inquiry, as the outcome of an
international conference held in 1996 at Cambridge University. Can you tell me some details about the cultural climate of the SSoM, which hosted some of the most influential scholars interested in opening the black box of biomedicine?
AC: When I joined McGill’s Department of Social Studies of
Medicine, I found, in some ways, the same kind of innovative and interdisciplinary intellectual environment that I had been privileged to experience at IHSPS. SSoM is a doubly interdis-ciplinary department in that it is a social sciences department located in the Faculty of Medicine, recently and tellingly renamed Faculty of Medicine and Health Sciences, and its faculty is drawn from a number of disciplines, in particular history, anthropology, and sociology. Despite my a-disciplinary training in STS, I was hired on a medical sociology position, and also appointed as an associate member of the Department of Sociology. I thus had to quickly expand my somewhat lacunar knowledge of mainstream medical sociology, a process that was facilitated by the fact that STS approaches had already begun to make their way into that domain, which allowed me to gradually move the content of my teaching in that direction. On the research side, of course, I had the latitude to develop a program focused on the analysis of biomedical practices. This was an emerging stream of research, reflecting a novel way of approaching biomedicine, by focusing on its content and practices, and breaking with traditional socio-logical approaches that adopted an ancillary position with respect to biomedical activities. This analytical turn was reflected in the decision to rename the department from social studies in medicine, to social studies of medicine. The interdisciplinary nature of the Department was bolstered by daily discussions with other faculty members. I was already familiar with the interface between the sociology and the history of science but, back then, I was ut-terly unfamiliar with medical anthropology. The presence within SSoM of two major representatives of that discipline, Margaret Lock and Allan Young, opened up new perspectives. Medical
anthropology has had a complex relationship with STS. Indeed, and in particular under the leadership of my two colleagues, it had begun to take an interest in the content of biomedical knowledge, in a way that paralleled the practice-turn adopted by STS. Unlike STS, however, it continued to cultivate a strong disciplinary identity. This led to many discussions both within the department and with our visiting colleagues, and also accounts for the book that you mention, or, to be more exact, for the conference that gave rise to this book. That meeting, to which we had invited both anthropologists and STS researchers, was a way of continuing our intra-departmental debates by exporting them into a broader framework.
SC: At the dawn of your career, the mainstream field of
medical sociology was dominated, among other perspectives, by the so-called «medicalization theories», which were formalized by Peter Conrad (1992), and strongly connected with works by Ivan Illich and Irving Kenneth Zola. How did you relate to this theoretical perspective?
AC: As already mentioned, several of my SSoM colleagues
were interested in studying the content of biomedical practices, i.e. the manufacture of biomedical knowledge. Traditional medical sociology was of course also relevant, but mainly for teaching rather than research. While my position was in SSoM, my job talk took place in a seminar room of the Department of Sociology, and I remember that the sociologists who attended the talk were somewhat bewildered by my presentation, especially since, with one notable exception (Roger Krohn) the STS perspective was not represented within the Department. The courses I taught did of course discuss a number of classic contributions such as Zola’s (1972) work on medicalization or Freidson’s (1970a; 1970b) work on the medical profession but, honestly, they did not have any major influence on my research. I subsequently designed a course called «Introduction to the Sociology of Biomedical Knowledge», which was obviously an STS-oriented course. When I presented the course proposal to the University committee in charge of approving new courses, they initially told me that there could be no such thing as a Sociology of Biomedical Knowledge insofar as biomedicine, and science more in general, was about objective truths, but I managed to convince them that it was a legitimate
course by pointing to the growing literature on the topic and the existence of professional societies such as the «Society for Social Studies of Science – 4S». I would like to emphasize that, from that point of view, McGill was a very open community, where even junior professors could make their voice heard provided they published in international journals and were able to attract grants. So, in short, from the very beginning my main audience has been the STS community rather than mainstream medical sociology, although a critical interface was very quickly established between these two domains (just remember the pioneering 1982 book edited by Wright and Treacher on The problem of medical
knowledge). For sure, there were initially some tensions, but all
that is now in the past.
SC: Remaining on the topic of studying biomedical practices
that mobilized STS sensitivity, you, together with Peter Keating, developed the notion of «biomedical platform» within the research monograph Biomedical platforms. Realigning the normal and the
pathological in late-twentieth-century medicine. Could you expand
on the genealogy of this notion and how it has contributed to reading biomedicine? It certainly differs from Michel Foucault’s concept of the «clinical gaze», which previously oriented the medi-cal sociology debate.
AC: Before answering this question, I would like to stress
that the work that will be discussed in the rest of this interview is inseparable from my collaboration with Peter Keating. Even though we are both products of the IHSPS, we each have our own conceptual and methodological sensibilities, Peter leaning more towards history and epistemology, and I towards sociol-ogy. Our co-authored texts reflect the hybridization, rather than the juxtaposition, of these perspectives. Taken individually, we would not have written the same books and articles. Your ques-tion posiques-tions the noques-tion of «biomedical platform» in relaques-tion to the infinitely more influential notion of «clinical gaze» (Foucault 1963). But if a link must be drawn between platforms and pre-vious work, it is less on Foucault’s side than on Canguilhem’s side that we must look for it, in particular with reference to the latter’s analysis of the normal and the pathological, as the subtitle of our book indicates (see Canguilhem 1972). We have sometimes been asked whether the notion of platform could be
applied to other sociotechnical fields (or even to the social sci-ences) and we answered that the question was moot insofar as the notion of platform cannot be dissociated from the issue of the relationship between the normal and the pathological. The neologism «biomedicine», whose beginnings and diffusion we have traced, conflates the normal and the pathological, hence the interest of analysing it from a critical reading of Canguilhem. From the lesson of Canguilhem we have retained the irreduc-ibility of the pathological to the biological, but we have also designated the platforms as the site where these two elements are iteratively realigned. The notion of platform also mobilizes traces of Bachelard, not the Bachelard of the epistemological break, but the one of «phenomenotechnique» (Bachelard 1934, see the Introduction), as further discussed in a 2016 article on the reassembling of diseases in the so-called post-genomic era (Keating et al. 2016). Finally, the term platform includes a nod to ethnomethodology’s perspicuous phenomena, as discussed by Michael Lynch (1993). We took up a term commonly used by biomedical practitioners while making it resonate with social science concerns. With the notion of platform, we wanted to introduce a unit of analysis that avoids resorting to dichotomies between the cognitive and the social, and between macro and micro-analysis and the metaphors, such as «context», that ac-company them. Biomedical platforms, their constitutive entities and those they engender, and the regulation that ensures their functioning make it possible to follow the cascade of transla-tions that provides for vertical and horizontal links between the heterogeneous components of this kind of assemblages.
SC: Indeed, this notion has proved very useful in the study of
so-called translational research, which tends to configure a kind of patient-oriented biomedicine. Could you go deeper into the field of translational research, which remains the subject of one of the most heated ongoing debates within the biomedical community?
AC: Introduced in the early 1990s by the US «National
Cancer Institute», the term «translational research» (TR) is more than mere rhetoric, nor can it be reduced to a financial object, as some have recently argued, although, obviously financial mat-ters do play a role. As we have tried to show by also using scientometric techniques (see Cambrosio et al. 2006a), it refers
to a set of concrete initiatives that accompany the emergence of new practices whose specificity needs to be identified. One should be careful not to equate the advent of TR with an «applied» turn in biomedicine, because, as we pointed out in the aforementioned article on the reassembling of diseases in the post-genomic era, we can say that, as noted by Hans-Jörg Rheinberger in his gloss on Bachelard (see Rheinberger 2005), rather than a science in search of possible applications, we are confronted with a research that is immediately deployed in the field of the applicable, at least in principle, and it is precisely this «in principle» clause that opens the door to an exploration of the various elements that will enable translational work to be carried out, beyond any simplistic and linear understanding of translational activities.
SC: A conceptual device you developed within the biomedical
platforms project is «regulatory objectivity» (see Cambrosio et al. 2006b), which was intended to explore the emergence of new forms of objectivity in biomedicine. Such forms of objectivity imply the production of rules and common ways of acting in bioclinical settings by means of a sociotechnical system for the production of evidence. This topic has made a comeback in the public debate in recent months because the SARS-CoV-2 pandemic has highlighted the uncertain, collective and processual nature of biomedical evi-dence production. In particular, I am thinking about the production and sales of new technologies for the diagnosis of Covid-19 or the definition of guidelines for managing Covid-19 patients. So, I ask you to reflect on the concept of «regulatory objectivity» in light of the current global pandemic, which is broadly reconfigur-ing public health programs.
AC: The notion of «regulatory objectivity» is indeed closely
linked to our work on biomedical platforms, insofar as regulatory processes (including the choice to exclude certain aspects from regulation) have provided us with an entry point for analysing the emergence and assemblage of platforms, while also allow-ing us to follow the work performed by these platforms. It is obvious that the reference to objectivity relies on the work of the historical epistemologists who have historicized this meta-notion, although in our case the goal was less to contribute to the philosophical debate per se than to identify the practices that
act as conditions of possibility of biomedicine and the systems of evidence on which it is based, which then led us to take a close interest in clinical trials. Now, as regards the second part of your question, the various controversies that accompanied the development of the coronavirus pandemic have focused, for instance, on the question of whether hydroxychloroquine was effective against the virus. This question soon became insepa-rable from the debate on the best way to produce evidence to answer that question. From this point of view, one could argue that the notion of regulatory objectivity can be useful in under-standing this episode, but I believe that it is too blunt a tool to contribute to a detailed analysis of a crisis of such nature and magnitude. The coronavirus pandemics, as brilliantly argued by Lachenal and Thomas (2020), resists any historical interpretation and, I would add, any reduction to pre-established sociological categories. Nobody could have anticipated that a virus (rather than, say, social movements) would, in so short a time, disrupt social, technical, economic, and cultural arrangements that were thought to be strongly embedded in the fabric of our societies. We should not expect a notion such as regulatory objectivity to do work for which it was not created: faced with a new situation, let’s try to innovate instead. Unfortunately, I noticed on some discussion forums that several social scientists have perceived the coronavirus crisis as an opportunity for reaffirming their pet analytical schemes rather than developing new analytical frames that take into account the unprecedented aspects and dimension of the pandemics.
SC: In fact, your research work has its roots in the study
of oncology, as highlighted by your latest book, Cancer on trial.
Oncology as a new style of practice, which was written with
Peter Keating (2012). For which reasons did you turn your atten-tion primarily to oncology, among the many medical specialties?
AC: There are several reasons for our interest in oncology.
First of all, there are practical reasons: our research on biomedical innovation has led us to study those platforms that have been deployed mainly in the field of cancer. We therefore decided to take advantage of the investments, in terms of acquaintance, connections, and so on, already made in this field. In addition, oncology has played a pioneering role in the adoption of
transla-tional research practices, particularly with respect to the interface between cancer and genomics. Given our focus on innovations, which cannot be analysed independently of routines, oncology is an ideal field of investigations, especially considering how it has transformed in a few decades from a relatively neglected domain to a major component, and market, of contemporary biomedi-cine. We accordingly felt that rather than limiting ourselves to the last two decades, we ought to encompass the beginnings of medical oncology, which led us to the analysis of the establish-ment of medical oncology as an innovation or, better said, «a new style of practice». A third reason has to do with the fact that many medical sociology studies focusing on the content of medical activities often used as case studies the «soft belly» of medicine, e.g. psychiatry or marginal nosological categories. While we understand that a view from the margins can be useful for unpacking the core of a domain, we were nonetheless interested in testing the potential and limits of sociological approaches on «hard cases» and use such an approach to reflexively rethink the sociological tools themselves.
SC: In the aforementioned book, you proposed the notion of
«style of practice», which combines Ian Hacking’s «style of
reason-ing» and Michel Foucault’s «dispositif». In so doing, you argue that attention to the practice allows one to capture the multi-situated and heterogeneous nature of the sociotechnical processes that occur in biomedicine. Could you provide more details about the theoretical reasons for the development of this notion?
AC: As just mentioned, we opted for analysing the emergence
of medical oncology as an innovation, rather than just looking at the emergence of innovations such as new platforms within the field. We thus needed a way of conceptualizing this shift in perspective. We also faced a practical issue: how to organize a book on a new assemblage: by devoting chapters to individual components, thus missing their mutual, interactive constitution, or by focusing on interactions between these components, thus confronting the conundrum of having to simultaneously introduce them? Ian Hacking’s use the term «styles of reasoning» seemed to provide a way out of this dilemma, but the term itself has cognitivist and epochal connotations. By re-centring and hybrid-ising it with a pragmatic sociology approach, it allowed us to
explore the innovation process by focusing on the emergence of new types of biomedical objects or entities, the establishment of new types of «evidence» such as results, explanations, and criteria for evaluating results; but also the creation of new forms of intersubjectivity. This type of approach is a continuation of our previous analyses, while broadening them. It is important to note that the notion of «style of practice», is a pragmatic inves-tigational guiding principle rather than a label to be affixed on whatever results one obtains. As such, it has allowed us to avoid a number of alternative frameworks, for instance institutional or conceptual histories of cancer, or political-economy analyses of the oncology market and oncology’s governmental-industrial complex: we wanted to combine these different aspects while of course not trying to respond to the impossible wager of producing a total or encompassing analysis of the field.
SC: In your empirical work, you often adopt a hybrid
meth-odological design, combining quantitative approaches – such as a scientometric approach, as you said before – with qualitative ap-proaches, namely, ethnography of biomedical practices. In this last part of the interview, I would like to ask you about the current methodological challenges social research is facing, especially the current status of ethnographic studies of large and globally dispersed phenomena, which are common in contemporary biomedicine.
AC: The fact that biomedical activities are increasingly global
and distributed does indeed pose a problem for ethnographic approaches, to which sociologists and anthropologists have tried to respond by developing methodologies such as «multi-sited ethnography» which, as the name suggests, consists of conducting comparative research in several sites rather than favouring the «thick description» of a single site. I have nothing against this approach which, in a way, is somewhat obvious, but it seems to me that it only responds imperfectly to the challenges you mention. Another solution is to choose investigational sites, both in the abstract and concrete sense of the term «sites», that have, so to speak, integrated the distributed and globalized aspects. For example, we recently chose to carry out fieldwork in a large, world-leading oncology centre, focusing on the units within this centre that maintain privileged horizontal and vertical links with other public and private, local and international institutions. This
allows us to follow practices at the micro-ethnographic level while observing, at the same time, the macro-structuring work produced by the actors.
SC: Within a co-authored position paper titled Big Data and
the collective turn in biomedicine (see Cambrosio et al. 2014),
you convincingly showed the two-fold nature of big data: on one hand, it can be viewed as an agent contributing to the develop-ment of biomedicine; on the other hand, it can represent a source of data for studying biomedicine itself. How can we revisit, in light of the growing importance of big data and related compu-tational approaches, the traditional tension between qualitative and quantitative approaches, or between local ethnographies and longitudinal studies?
AC: The use of (semi-)quantitative approaches such as those
developed by computational sociologists is another, complementary way of tackling the problem raised by the previous question. But it is not without its own problems, for reasons discussed in the article you mention and in a more recent text for a special issue of «Quantitative Science Studies» (QSS) on the relations between qualitative and quantitative approaches in STS (see Cambrosio et al. 2020). Broadly speaking, there is a «mismatch» between the notions of biomedical networks and collectives used by researchers who identify themselves with actor-network theory (ANT), a.k.a. the sociology of translation, and the notions of networks and clusters used in (social) network analysis. Moreo-ver, the data that can be extracted from online databases, such as Web of Science or Scopus, or scrapped from social media such as Twitter and Facebook embed epistemic and ontological choices that we unknowingly mobilize if we do not use them in a reflexive way. Similarly, algorithms such as those proposed by topic modelling3 cannot be used blindly, i.e. without questioning
their premises. The QSS article also mentions possible solutions to these problems, but they are always partial solutions that, in my opinion, require a continuous to-and-fro between qualitative 3 Topic modeling algorithms are part of machine learning methods for discovering
hidden thematic patterns in large dataset. Given a corpus as input, a topic modeling procedure can generate a set of «topics», that is a group of words, which coherently define a unique and peculiar topic. Furthermore, topic modeling can assess the extent to which each single document of the corpus shows those topics. See Di Maggio et al. 2013.
and quantitative approaches. I am involved in a project that explores precisely this type of interaction, but this has led me to realize how difficult such a path is.
SC: You just mentioned topic modelling for exploring large
document corpora. I would like to ask you about the ways in which these techniques, or, more precisely, algorithms, which were not developed primarily for the social sciences, can help sociolo-gists to analyse large textual corpora and understand certain social phenomena in an innovative way.
AC: Let me first emphasize that while I am «dabbling», so
to speak, in quantitative methods to investigate medical activities, my research remains mainly grounded in qualitative approaches. Now, back to your question: generally speaking, I was initially a bit skeptical about computational techniques, including network analysis, but I subsequently changed my mind. As I already mentioned, I entertained close connections with the Center for the Sociology of Innovation (CSI) at Mines ParisTech, where, in the 1980s, Michel Callon and colleagues developed co-word analysis and a software called LexiMappe modeled after the tenets of ANT (see Callon et al. 1983). In a co-authored paper, we used Leximappe to analyse the emergence and constitution of «biological safety» as a new techno-scientific domain (see Cambrosio et al. 1993). I subsequently began to collaborate with Andrei Mogoutov, the developer of ReseauLu, a more advanced software for the analysis of heterogeneous networks, and more recently with Jean-Philippe Cointet, the developer of the CorText platform that includes a Natural Language Processing module and is, so to speak, ANT-compatible insofar as it allows one to relate human actors to non-human objects, namely technologi-cal devices, biologitechnologi-cal entities and so on (see CorTexT 2012). I am still convinced that we cannot rely uniquely on quantitative methods, but, rather, need to develop solutions that allow for a recursive analytical path between those methods and ethnographic investigations. I am now involved, together with Jean-Philippe and two other colleagues (Alexandre Hannud Abdo and Pascale Bourret) in the development of a novel computational sociology approach that, beyond topic modelling, is designed to facilitate the integration of computational methods and ethnographic observa-tions (see Abdo et al. 2019). The idea is to produce multi-level
investigations of the structure of research activities, by elaborating a two-fold description of textual corpora (e.g., conference abstracts or grant proposals) in terms of scientific domains (collections of documents) and topics (collections of words), and by extending this description to clusters of associated dimensions, such as time. The analysis and interpretation of the output, however, relies on the intervention of an ethnographer who has already carried out a fieldwork about the scientific activities under scrutiny, and who is thus aware of the nature of the practices at stake in the relevant field. Computational methods that go beyond cita-tion analysis and other tradicita-tional scientometric approaches can be very useful, provided that they are not considered as an end-in itself, but as a component of a broader project where they can be recursively interfaced with qualitative material and ethnographic investigations, allowing us to interact with data in an innovative manner. The problem is that these methods are complex and it is sometimes hard to interpret and relate their outputs to other results characterized by a different degree of granularity. The collaboration between the qualitative and the quantitative researcher requires the development of a middle language that will allow, for instance, qualitative researchers to understand quantitative approaches without necessarily being able to implement them, and vice versa. Indeed, it is crucial to be aware of each other’s approaches and be open to questioning, on that basis, one’s own methods and interpretations.
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Stefano Crabu, Department of Design, Politecnico di Milano, Via Du-rando 38A, I-20158, Milano. E-mail: stefano.crabu@polimi.it.
Alberto Cambrosio, Department of Social Studies of Medicine, McGill University, 3647 Peel, Montréal. E-mail: alberto.cambrosio@mcgill.ca.
