Medicine And Books

Crafting Science: A Sociohistory of the Quest for the Genetics of Cancer; Between Bench and Bedside: Science, Healing, and Interleukin-2 in a Cancer Ward

BMJ 1997; 315 doi: (Published 15 November 1997) Cite this as: BMJ 1997;315:1318
  1. Steven Shapin
  1. Department of Sociology and Science Studies Program, University of California, San Diego, USA

    Crafting Science: A Sociohistory of the Quest for the Genetics of Cancer

    Joan H Fujimura Harvard University Press, £29.95, pp 322 ISBN 0 674 15553 0

    Between Bench and Bedside: Science, Healing, and Interleukin-2 in a Cancer Ward

    llana Löwy Harvard University Press, £26.50, pp 370 ISBN 0 674 06809 2

    Many years ago, a friend who had just been interviewed by a sociologist said, more in sorrow than in anger, “She didn't seem interested in what I did.” What he meant was that he spent much of his day calculating the energies of subatomic particle interactions, and the sociologist never asked him anything about that. This was “technical stuff,” and, while you might not expect a sociologist know much about such things, this was what my friend was trained to do and what gave him his identity as a scientist of a certain kind. So, even if it was understandable that sociologists might choose to pass by on the other side of the technical, a sociology of science without the science still seemed an odd sort of enterprise.

    About 25 years ago, sociologists began to agree: sociologists had to become “ethnographers,” hanging out where knowledge was made and learning the culture of those places. Science was still to be understood in its collective aspects—that's why sociologists tend to be interested in interactions rather than in individuals—but what made scientific collectivities communities of a certain sort was what they knew together and what they knew how to do together. There was no way to find out about that except by getting stuck into their cultures.

    Fujimura is an American sociologist who took some training in molecular biology to better enable her to interview leading Californian oncogene researchers; Löwy is a French immunologist turned historical sociologist who had problems persuading her subjects at a Parisian cancer institute that she really was no longer a scientist. Their books belong to the second generation of ethnographic work in the sociology of science and medicine. Each author has her favoured brands of sociological method and theory, and each aims to make an important contribution to method and theory. Both books are about modern biomedical research related to cancer, but you would not want to read these books if your main interest was to find just a definitive account of the emergence of oncogene research (Fujimura) or of clinical trials on the candidate anticancer drug interleukin-2 (Löwy). You would have to be interested, at least a bit, in what fascinates sociologists about science and medicine these days and what broad conclusions they have come to.

    Sociologists are interested, among other things, in the political nature of science. In the older dispensation, what was taken to be political about science and medicine—Labour versus Conservative funding arrangements for the Medical Research Council, lobbying governments for a new particle accelerator, illegitimate ideological influences on, say, Soviet genetics—was distinguished from what was “properly scientific.” And to say that scientific or medical judgment was politically influenced was to say that it was suspect or corrupt. By contrast, Fujimura and Löwy are interested mainly in what might be called the constitutively political nature of technical judgment: political processes as something that cannot be got rid of for anything recognisable as science to exist.

    Decisions about whether or not to jump on what both Fujimura and her subjects call the “oncogene bandwagon” are rightly called political because they are judgments under uncertainty about the likely consequences of collective courses of action. What “everyone is doing” becomes an objective factor in one's own decision about what kind of research to do. The development of standardised instruments and techniques—Du Pont's OncoMouse, the Ames test for mutagenicity, the famous Cold Spring Harbor manual on molecular cloning, the protocols regulating the clinical trials so extensively described by Löwy—are also importantly political.

    The validity of inference from trial to natural populations, from in vitro to in vivo, can never be guaranteed by logic alone. We can never know with absolute certainty, but can only be adequately assured, that the one properly stands for the other. The processes by which biomedical communities settle on criteria for adequate tests and trials have to contain a political component, and, again, no aspersion rightly attaches to such a notion.

    Since the path, for example, from a test tube containing interleukin and leucocytes in the laboratory to a sick patient in the clinic cannot be traversed by pure reason, communities have to be persuaded, and then decide as best they can, that the “standing for” association is legitimate. The gap between test and reality that cannot be wholly filled by logic has to be filled by communities' accepted stocks of convention, rhetoric, and persuasion—in a word, by politics. These political processes may be directed towards, in Löwy's study, the differing sensibilities, interests, and risk orientations of scientists and clinicians, or, in Fujimura's materials, to different technical communities' pragmatic preferences about “the right tool for the job”: what kinds of test systems are robust, reliable, and domesticated; how difficult it is to acquire new instrumental skills; what links exist between new and old sets of skills.

    Fujimura and Löwy are far from alone in being sceptical about the existence of a clear, coherent, and universally efficacious “scientific method” that unambiguously tells scientists what decisions to make in such cases. Like the immunologist Peter Medawar, they tend to hold that “there is no such thing as The Scientific Method,” and, like the molecular biologist Mahlon Hoagland, they stress contingency, uncertainty, and “much fumbling in the dark.” Circumstances alter cases, and sociologists now increasingly take their role to include writing those richly detailed, “warts and all” narratives about everyday scientific practice that are so vigilantly excluded from introductory textbooks and fanciful philosophising.

    The effect may be rather disconcerting to a reader picking up a sociologist's account, possibly expecting to find some global “covering law” explanation of how science or medicine works. In place of any such general theory, these books tend to offer something closer to a fly on the wall, documentary cinema. Its subjects may easily recognise themselves in the product, while being perhaps a little queasy about whether they want such a picture publicly circulated.

    Should biomedical scientists be upset with these sorts of accounts? Of course not. They make science much more interesting than traditional accounts. There really is no avoiding the cliché here: they make science seem a genuinely human endeavour. For my taste, recent sociology of science—far from denigrating science—paints a picture that represents science as a more complex and delicate achievement, that better shows what an extraordinary human accomplishment it is. And if stories about the social and political nature of science seem to some as denigration, that is probably just because of the grip of those simplistic philosophical stories that identify the social and the political with forces that can only corrupt science. But why any scientist should want to hitch the defence of science to discredited philosophy is very puzzling.


    The giant bubble chamber at CERN, from Science in the Twentieth Century, edited by John Krige and Dominique Pestre (Harwood, £80, ISBN 90 5702 172 2), an encyclopaedic popular text of nearly 1000 pages with 50 contributors and several chapters on medical topics.

    Rating: **, ***

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