Recent scholarship in medical humanities has expressed strong concern over the ability of pharmaceuticals companies to medicalize discomfort and subsequently invent diseases. In this article, I explore the clinical debates over the ontology of the sinus headache as a possible counter-case. Extending Foucault’s concept of principles or rarefaction, this paper documents the efforts of clinicians to resist the pharmaceutically-provided understanding of the sinus headache. In so doing, it offers institutions of rarefaction and rarefactive assemblages as useful heuristics for the exploration (...) of disease legitimization discourse. (shrink)

This article offers a hybrid rhetorical-qualitative discourse analysis of the FDA’s 2011 Avastin Hearing, which considered the revocation of the breast cancer indication for the popular cancer drug Avastin. We explore the multiplicity of stakeholders, the questions that motivated deliberations, and the kinds of evidence presented during the hearing. Pairing our findings with contemporary scholarship in rhetorical stasis theory, Mol’s (2002) construct of multiple ontologies, and Callon, Lascoumes, and Barthe’s (2011) “hybrid forums,” we demonstrate that the FDA’s deliberative procedures elides (...) various sources of evidence and the potential multiplicity of definitions for “clinical benefit.” Our findings suggest that while the FDA invited multiple stakeholders to offer testimony, there are ways that the FDA might have more meaningfully incorporated public voices in the deliberative process. We conclude with suggestions for how a true hybrid forum might be deployed. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Scale Theory: A Nondisciplinary Inquiry by Joshua DiCaglioS. Scott GrahamScale Theory: A Nondisciplinary Inquiry. By Joshua DiCaglio. Minneapolis: University of Minnesota Press, 2021. 349 pp. Paperback: $30.00. ISBN: 978-1-5179-1207-9.Scale Theory embodies its title in every possible way. It offers both a deep dive into and a 10,000-foot view of scale, scalar thinking, and the role of scale in scientific inquiry. The subtitle, A Nondisciplinary Inquiry, is no less (...) apt. Author Joshua DiCaglio blends insights from rhetoric, philosophy, literary studies, and mysticism to create a novel account of scalar thinking. In so doing, he weaves together detailed thought experiments, the work of Gregory Bateson, and Philip K. Dick's account of an extraterrestrial communication he received while under the influence of anesthesia. Provocatively, Scale Theory treats these diverse intellectual resources as coequal contributors to an emerging theory of scale and scalar thinking. Within this nondisciplinary framework, the book is devoted to advancing two primary theses: (1) Notions of scale are undertheorized in science studies and related strands of new materialisms; and (2) Proper attention to questions of scale within these theoretical traditions should prompt a more thoughtful reconsideration of the merits of mystic holism. Ultimately, Scale Theory makes a compelling case for the first thesis and advances inquiry usefully in this area. With respect to the second thesis, DiCaglio refers to a certain academic "allergy" to holism (99), and I must confess I share this allergy. That said, I assume readers already predisposed favorably toward mystic holism are likely to find Scale Theory's attention to the second thesis thoughtful and engaging.Scale Theory is organized into three distinct parts. Part 1, "Algorithms for a Theory of Scale," presents three interrelated thought experiments that call upon readers to imagine themselves at various distances and vantage points with respect to several objects of interest. Part 1 is stylistically [End Page 388] Wittgensteinian. Like the Tractatus-Logico Philosophicus (Wittgenstein 2013) or Latour's "Irreductions," (1993), the thought experiments unfold as a series of numbered and nested propositions, each postulating or interrogating an emerging concept in DiCaglio's theory of scale. Part 2, "Configurations for a Theory of Scale," returns the reader to more familiar styles of prose, providing a sort of review of the relevant literature and its relationship to the insights of the thought experiments. Finally, part 3, "Rhetorical Technologies for a Theory of Scale," reflects on the twin marginalizations of rhetoric and mysticism in mainstream Western academia and argues for a new embrace of disembodied inquiry.The aforementioned thought experiments of part 1 outline DiCaglio's theories of scale, scalar thinking, and scalar analysis. The discussion makes extensive use of visual and cinematic metaphors to aid the reader's consideration of scalar questions. Ultimately, DiCaglio posits that scale is a function of the relationship between the "'being' of phenomena" and "the one who is measuring" (8). He argues, therefore, that "scale functions at a level above ontology and epistemology: scale is a means of orienting yourself both to experience and the being of things" (8). In making this argument, Scale Theory reflects on a range of scientific practices that require gradients of scale. Microscopy, telescopy, and simulations all provide scientists with tools to escape the mundane scales of embodied human experience. DiCaglio argues that "science must always find itself grouping things together, speaking of species, types, systems, and so on which exist on a different logical type than the individual encounters that make up these groups" (41). The taxonomic activities of scientific practice require shifts in scale to account for kingdoms, phyla, orders, genera, species, and all manner of nonbiological analogs.Within this framework, scale functions as a sort of meta-ontology that allows objects to be provisionally identified and delineated. Echoing Bateson, DiCaglio argues thatIn order for any thing to be said to exist whatsoever, a differential must exist out of which a difference can be discerned. Every differential occurs on some scale at which a fluctuation or movement is able to make a difference. If one goes to a smaller scale, any given differential is no longer able to be used to register a difference.(51... (shrink)

Introduction Financial conflicts of interest (fCOI) present well documented risks to the integrity of biomedical research. However, few studies differentiate among fCOI types in their analyses, and those that do tend to use preexisting taxonomies for fCOI identification. Research on fCOI would benefit from an empirically-derived taxonomy of self-reported fCOI and data on fCOI type and payor prevalence.Methods We conducted a content analysis of 6,165 individual self-reported relationships from COI statements distributed across 378 articles indexed with PubMed. Two coders used (...) an iterative coding process to identify and classify individual fCOI types and payors. Inter-rater reliability was κ = 0.935 for fCOI type and κ = 0.884 for payor identification.Results Our analysis identified 21 fCOI types, 9 of which occurred at prevalences greater than 1%. These included research funding (24.8%), speaking fees (20.8%), consulting fees (18.8%), advisory relationships (11%), industry employment (7.6%), unspecified fees (4.8%), travel fees (3.2%), stock holdings (3.1%), and patent ownership (1%). Reported fCOI were held with 1,077 unique payors, 22 of which were present in more than 1% of financial relationships. The ten most common payors included Pfizer (4%), Novartis (3.9%), MSD (3.8%), Bristol Myers Squibb (3.2%), AstraZeneca (3.1%), GSK (3%), Boehringer Ingelheim (2.9%), Roche (2.8%), Eli LIlly (2.5%), and AbbVie (2.4%).Conclusions These results provide novel multi-domain prevalence data on self-reported fCOI and payors in biomedical research. As such, they have the potential to catalyze future research that can assess the differential effects of various types of fCOI. Specifically, the data suggest that comparative analyses of the effects of different fCOI types are needed and that special attention should be paid to the diversity of payor types for research relationships. (shrink)