Trial and Error: How The Search for Anticancer Drugs Fragmented Cancer Diagnosis

• In Event: 262 - Section on Science, Knowledge, and Technology Refereed Roundtable Session and Business Meeting
  In Refereed Roundtable 60min: Table 03.

Abstract

This paper examines the fragmentation of cancer into multiple diagnoses between the mid 1940s until the mid 1970s to explore mechanisms of diagnosis specification. This fragmentation was not a result of a linear-rational unfolding of a scientific theory, but of institutional restructuring in an era lacking a scientific paradigm. This restructuring created a new platform combining therapy and experimentation: chemotherapy clinical trials. We contribute to literature on medical diagnosis and to literature on standardization in evidence-based-medicine by showing the new diagnosis-generating mechanisms created through the emergence of clinical trials and the search for cancer cures. We argue that pragmatic need to improve anticancer drugs led researchers to homogenize patient samples and narrow down trial’s recruitment criteria, thus creating refined diagnostic schemes. We show that prognostic variables used in clinical trials to predict patients’ responses to treatment turned into recruitment criteria in subsequent trials and eventually created new diagnostic schemes. We show how this process was enabled as clinical trial created new incentives and opportunities to measure and quantify cancers’ behaviors that resulted in proliferation of new ‘numbers’ allowing new ways to classify patients. Finally we show how the specification of diagnosis, increasing the difficulty to recruit patients, reinforced trials’ ‘golden status’ and the authority of bio-statisticians. Smaller patient pools reinforced the need for institutional collaboration, thus increasing the need for sophisticated statistical methods of standardization and data analysis. The fragmentation of cancer has vast socio-political implications as it interacts with demographic categories (e.g. race, sex) underlying socioeconomic inequality.

Author

• Moran Levy, Columbia University in the City of New York