Contenu du sommaire : Essais cliniques, production de la preuve et mutations de la biomédecine

Therapeutic regimens and proofs in oncology : the organization of clinical trials from cooperative groups to research consortia. Grounded in an empirical analysis of the development of medical oncology from the 1960s-present, this paper explores the mutually constitutive relation between epistemic and organizational innovation. In particular, it examines how, confronted with a ‘similar' issue —the promotion of stronger interactions between pre-clinical and clinical work —1960 oncologists and their turn-of-the-century colleagues developed different solutions, in spite of powerful path-dependency effects. These different outcomes cannot be reduced to the actors' strategies or to a political sociology of science that neglects the content of bio-clinical practices. They correspond to two distinctive socio-technical networks that can be better understood by focusing on oncology's regimens, and the sequence of framings and overflows they engender. Social scientists continue to debate whether organizational innovation leads to cognitive innovation or vice versa, and are still caught in the opposition between configurational (static) and dynamic analysis. Regimens provide a heuristic alternative to these dichotomies. It remains to be seen whether this approach can be applied to domains other than oncology, thus bypassing the opposition between objects (entities) and practices.

Fort the common good and everyone interest. Clinical trial and organizational innovation in psychosurgery. This paper plots out the history of the development of a French multi-center clinical trial in psychosurgery (i.e. surgery for mental disorders). Based on ethnographic observation, it sets out to explore the way in which a collective of clinicians and researchers succeed in developing a viable, innovating practice by adapting the technology to scientific and ethical stakes and constraints that render the undertaking more complex. This article questions how a clinical trial can be used as a strategic resource and a venue for reflection and innovation locally adapted to the context of its implementation. Finally, this clinical trial came to be an organizational innovation which shifted the focus from the demonstration of the treatment efficiency towards the creation of an innovating psychiatric research network in France.

Dementia, between laboratory and market
In the last two decades, social science research on clinical trials has developed along mainly unconnected strands, one focusing on epistemic practices and cultures of clinical trials and the other seeking to link clinical trials to wider transformations in the exercise and distribution of power in the neo-liberal order. In this paper, I propose an empirical approach to analyse both the epistemic and the political dimensions of clinical trials. How are the knowledge making procedures of clinical trials related — in practice — to the political formatting of biomedicine and health care ? To address this question I explore the dynamics of a public controversy about the value of therapeutics for clinical dementia in the United Kingdom between 2005 and 2008. I suggest that this controversy opposed two regimes ways of linking knowledge to health care policy. On the one hand, there was a mobilisation of ideals of efficiency based on the deployment of cost-utility instruments, belonging to a ‘market' formatting of health care. On the other hand, there was a reliance on an ideal of effectiveness, invoking a tradition of experimental science and an idealised version of the laboratory's role in the establishment of social order.