Catherine Will and Tiago Moreira (eds): Medical proofs, social experiments: Clinical trials in shifting contexts

Abstract

More than half a century ago, physicians began to struggle with how to assess the efficacy of treatments. As the late Harry Marks documented at length, around the 1950s, the two alternatives considered for making these assessments were the casebased judgment of individual experts and the results of randomized clinical trials (RCTs). However, after only a few decades, it is evident that the RCT has reached the apex of the hierarchy of clinical evidence, where it remains despite the objections of a number of dissenting doctors, philosophers, and sociologists. The compilation edited by Catherine Will and Tiago Moreira brings us a selection of the most recent sociological literature on this topic. Clinical histories and sociological case studies differ, of course, in many respects, but it is interesting to note, as the editors themselves present it, that this book constitutes a vindication of case-based reasoning against the purported generality of RCTs. In these latter, we assume that we are dealing with a representative sample of patients and a standardized treatment protocol, allowing us to generalize our conclusions beyond the trial. The case studies compiled in this book question the possibility of such generalization: as the editors conclude, information about how clinical trials are organized and carried out goes beyond reporting of methods and is crucial for critical interpretation of evidence. This information should be compiled precisely through case studies of each medical experiment, bridging the gap between the agents defined in the research protocol and the communities and contexts where these protocols are implemented. In other words, in evaluating treatments, perhaps we can dispense with clinical judgment about individual patients, but we still need expert judgment about the circumstances of each individual clinical experiment before we can generalize its conclusions.