Research seminar hosted by Centre for Health Technologies and Social Practice 7th June 2018 12pm-2pm (lunch provided at 12pm)
12.21 & 12.25 Social Sciences Building
The network of genomic expertise: Investigating bio-clinical decision-making in cancer precision medicine
Pascale Bourreta& Alberto Cambrosiob
a Aix Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France;b Department of Social Studies of Medicine, McGill University, Montreal, Canada
Oncologists argue that the uncertainties surrounding the clinical interpretation of genomic alterations constitute the most severe bottleneck preventing the implementation of personalized cancer medicine. Molecular tumor boards (MTBs) are a way of coping with this issue. Attended by clinicians, bio-pathologists, molecular biologists, biostatisticians, and bioinformatics specialists, MTBs provide a bio-clinical platform to assess the clinical significance of the results of tumor profiling and make therapeutic recommendations on that basis. They link genomic platforms to clinical practices by establishing ‘actionable’ connections between drugs and molecular alterations. Their activities rely on a heterogeneous set of evidential resources — databases, knowledgebases, clinical trial results, previous clinical experience, basic knowledge about mutations and pathways — that need to be associated to the clinical trajectory of individual patients. MTBs co-produce data and their interpretation, insofar as collectively engendered ‘relevant data’ act both as the input for their interpretative activities and as the outcome of those activities. Based on the ethnographic analysis of the activities of a number of MTBs in North America and Europe, the paper centers on the new kind of expertise deployed within/by MTBs: its emerging and evolving nature, its collective and distributed structure, the ‘evidential equipment’ that underlies it, and the different pragmatic strategies it deploys to reach the shared goal of providing ‘informed’ data interpretations.