This article explores some implications of the increasing reliance on clinical trials in contemporary health care, particularly health care payers’ efforts to use them in the so-called fourth hurdle decisions. How do these agencies manage medical uncertainty given the desire to produce clear guidelines for clinicians? Their solutions take account of trials in at least two ways, reflecting broader debates about the meaning of these medical experiments. Trials can be read as either ‘‘proofs of protocol’’—straightforward guides to action with individual (...) drugs in specific populations—or ‘‘proofs of principle’’— where extrapolation is made possible through an appeal to underlying biological mechanisms. These contrasting readings of trials are illustrated with reference to guidelines on heart disease prevention/cholesterol reduction using statins among the elderly in North America and the United Kingdom. Uncertainty in these cases does not lead to inertia but solutions use different fixed points to aid navigation, including both physiological principles and moral values. (shrink)

This guest editorial opens with a brief overview of the transformations of medicine and mental health that can be observed since the second half of the twentieth century. New genetics and biotechnologies hold out the promise of overcoming presumed limitations in the field of mental health care, that is, the fact that diagnostic procedures in psychiatry and clinical psychology still largely rely on the narratives of patients and questionnaires, supposedly subjective assessments by physicians and psychologists. It is envisioned that innovative (...) genetic and proteomic tools, imaging technologies, and objective laboratory tests for blood biomarkers will enable better diagnosis and treatment of mental diseases. We argue that emerging biotechnologies do not revolutionize mental health, despite their promise to do so. Instead, we observe a pluralization of research and treatment approaches in the domain of mental health. The second part of this editorial discusses the contributions to this special issue on emerging biotechnologies and mental health and outlines how they address some of the gaps in social studies of psychiatry and mental health in the twenty-first century. (shrink)

Contemporary debate suggests that the new genetics may be changing ideas about the body and what it is to be human. Specifically, there are notions that the new genetics seems to erode the ideas that underpin modernity, such as the figure of the integrated, discrete, conscious individual body-self. Holding these ideas against the practices of genetic medicine, however, this article suggests a quite different picture; one that does not erase, but helps to keep in play, some crucial tenets of humanism. (...) The article examines how the genetic clinic constructs clinical pictures as new forms of portraiture: assemblages in which multiple and heterogeneous images of bodies and their parts are juxtaposed. Rather than these portraits just making the distributed and hybrid nature of personhood explicit, shifts in ground mean that what is being portrayed is the possibility of a ‘syndrome–genotype’ relation. At first sight this appears as a straightforward geneticization of the body and the unravelling of the figure of the individual. But the article illustrates how, at the same time as the portraits of syndrome–genotypes are made up of many heterogeneous parts, the clinic still keeps in play an idea of persons that remains, unlike their bodies, much more than the sum of their parts. All the parts that make up the body of the person can still, at moments, be transcended, to refigure the human: the complex individual of humanist thought. (shrink)

Many research-intensive universities have moved into the business of promoting technology development that promises revenue, impact, and legitimacy. While the scholarship on academic capitalism has documented the general dynamics of this institutional shift, we know less about the ground-level challenges of research priority and scientific problem choice. This paper unites the practice tradition in science and technology studies with an organizational analysis of decision-making to compare how two university artificial intelligence labs manage ambiguities at the edge of scientific knowledge. One (...) lab focuses on garnering funding through commercialization schemes, while the other is oriented to federal science agencies. The ethnographic comparison identifies the mechanisms through which an industry-oriented lab can be highly adventurous yet produce a research program that is thin and erratic due to a priority placed on commercialization. However, the comparison does not yield an implicit nostalgia for federalized science; it reveals the mechanisms through which agency-oriented labs can pursue a thick and consistent research portfolio but in a strikingly myopic fashion. (shrink)

This article considers the experiences of health consumers who have undergone testing for human immunodeficiency virus antibodies, T cells, and viral load. These HIV-related tests are deployed for the purposes of making definitive diagnoses; yet some test consumers experience ambiguous outcomes. Drawing on an analysis of differing end-user experiences of these tests, where consumers' knowledge reflected the multiplicity and heterogeneity in test design, the author explores how these experiences reflect particular knowledges about these tests. The article contributes to efforts analyzing (...) how health consumers are active end users co-constructing the social meaning of technologies in mutual relationship with other users. The author discusses how this new knowledge can be used to delineate a greater role for consumer evaluation of medical testing within a broader understanding of test design and performance. Relevant links are made to issues such as genetic testing and assessing claims about the efficacy of medical tests. (shrink)