Paper long abstract:

'Personalized Medicine' (PM) is a new biomedical paradigm, that represents a case study of a new technoscientific-biomedical knowledge structuring process. During the last decade PM entered into the mainstream of the medical discourse, perceived as a solution for many medical institution's encumbrances.

In recent years insurance companies strengthen their position in the Israeli health system, due to the legislation of the National Health Insurance Law. The insurance companies started to market health insurance plans, which mostly covered and compensate serious illnesses, transplants and funded drugs that are not included in the national list of health services (healthcare basket). 'Phoenix', a commercial insurance company, which sells commercial health insurances plans, recently began to market a new health plan insurance called "Genetix - PM based on Genetics". This plan is the first one that focuses on the genetics features of their insured population. With this Genetix plan, Phoenix is trying to formulate the PM discourse in order to become a new influence actor in the Israeli Health System.

In this lecture, I will present initial findings from my PhD study that focuses on mechanisms of knowledge transmission and dissemination, from the laboratories to bedside medicine, analyzing these processes from technoscientific perspectives. The presented findings will focus on the discourse practices which are used by Phoenix in their marketing plan, based on the assumption that in this way, the company is trying to consolidate its position as an actor in the knowledge network.

Paper long abstract:

Radiotherapy, the treatment of cancer with high energy x-rays, has been facing rapid technological change since before the turn of the century. Linac Adapted Conebeam Imaging (LACI) was introduced at the Sieverts Hospital with the aim of improving the accuracy of radiotherapy treatments through a process called Image Guided Radiotherapy (IGRT). An ethnography of the installation shows that as the LACI is introduced and glitches are overcome with workarounds and hidden work, it gains momentum and a history that serves to give the technology importance within the practices and departments in which it is located.

This paper examines the trajectory of Linac Adapted Conebeam Imaging (LACI) technology in the Sieverts hospital site in the United Kingdom. Using this case study I build an argument to develop the idea of cone beam imaging as a "baroque" technology to highlight the ways in which demands for newness lead to technological changes with potentially unproven benefits to patient care. Indeed, as the case study shows, these changes may even impede such care: complicating the formation of new solidarities and disregarding the position of the patient who is assumed to benefit.

Paper long abstract:

My contribution aims at looking the emergence of a "new technique" in the field of assisted reproductive technologies (ART). Although currently ART is universally known as IVF (In Vitro Fertilization), exploring it inside laboratories allows to see how the more used technique is nowadays ICSI (Intracytoplasmic Sperm Injection). ICSI was introduced as a solution to severe male infertility problems and as a possible alternative to the donation from third party donors. By using a single spermatozoa, ICSI permits the fertilization of an oocyte even in severe cases of male infertility. Since its introduction, the percentage of use of ICSI has dramatically increased. International data show that ICSI is currently used most often. Despite several professional opinion leaders in the ART field have recently criticized the overuse of ICSI, its success continues unabated.

The progressive passage from the old to the new technique is integrated into a controversial technology and tied to knowledge processes that are developed through organizational activity and tied to the institutional setting. Focusing on these aspects, my paper will explore several factors (organizational, social and cultural aspects) that explain the disproportionate use of ICSI. Moreover, ARTs are not seen as socially controversial technologies. A reflection on their development in terms of how they became socially acceptable and desirable is missing in the debate. In order to narrow this gap, I will explore dominant unquestioned path regarding the use of ARTs and ICSI as a common alternative for overcoming unintended childlessness.

Paper long abstract:

Translational nanomedicine is promoted as an emerging biomedical field, capable of opening a therapeutic scenario where treatments will become personalised and individuals will take an increasingly active role in the control of their daily well-being. In this sense, the standard view of nanomedicine, supported by the biomedical community, seems characterised by a "future-oriented debate" that is to be understood as the complex "outcome" of scientific narrations arising from the potential application of nanotechnology in the context of patient care.

In this domain laden with hopes for biomedical sciences, the ongoing dialogue between nanotechnology and biotechnology is a topic of undoubted importance for Science and Technology Studies. In the last decade, plenty of contributions shed light on how "forward-looking statements" on scientific and technological progress may be regarded as rhetorical devices capable of attracting the attention of relevant stakeholders, together with a number of financial, regulatory and symbolic resources for the establishment of new biomedical technologies.

Starting from these theoretical suggestions and based on the data collected during an ethnographic research that was carried-out in a laboratory of nanomedicine based in Northern Italy, this paper explores the relationship between scientific "forward-looking statements" and the situated practices of biomedical research in nanomedicine. In doing so I develop the concept of promissory bio-object as a concept of better understanding the engagement of anticipatory knowledge in biomedical research with a specific emerging biomedical device called "triangle DNA origami".

Paper long abstract:

Recent advances in genomics - including sequencing technologies and their novel uses in clinical settings - are believed to herald the advent of personalized medicine, enabling more efficient diagnostics, optimizing treatments delivered to patients and improving quality of life. One of the challenges of this move towards "personalization" is aligning current understandings of disease-causing mutations and genetic dispositions with clinical practices and health policies. The intervention of "next-generation" genomic technologies and the generalized use of genomic information are often described as playing a key role in this translation. However the actual practices involved in articulating the different collectives engaged in this movement is not well documented.

This contribution is based on interviews with industrial actors and an ongoing ethnography of a French trial in oncology involving next-generation sequencing. It aims at highlighting the role played by genomics companies along the translational continuum spanning from basic biological research biology to clinical research and trials. I suggest that platform builders in genomics do not simply commercialise integrated systems of hard- and software that enable the acquisition, treatment, analysis and circulation of genomic data. They actively engage with researchers, clinicians, healthcare experts and policy-makers in a variety of settings, and help articulate these social worlds. This involvement in the definition of technical protocols, interpretive schemes, quality standards and best practices, in issues of clinical certification and accreditation, or ethical conundrums (eg. management of incidental findings) helps build trust in - and shape the converging uses of - the generic technologies of genomics.

Paper long abstract:

A novel imaging technology, tomosynthesis, was adopted for use at a university hospital in Sweden in 2006. The superiority of tomosynthesis over x-ray in depicting pathologies associated with cystic fibrosis, a degenerative genetic disease, was soon discovered, while the existing "gold standard" for this work remains CT scanning. The advantage of tomosynthesis over CT has to do with patient safety (less radiation) and cost-effectiveness. This longitudinal, ethographic case-study follows the emergence of a prospective standard for monitoring the progress of cystic fibrosis using tomosynthesis through the work of an interdisciplinary team of radiologists, medical physicists and educational researchers.

Daily hospital work is permeated with medical standards, which align a plethora of heterogeneous actors into standardised practices. When a new technology is adopted, the alignments will shift. How do the divergent actors draw upon the standardised practices and reorganise themselves around the new technology? How does a widely accepted scoring system used with CT- "Brody's score"- become converted for use with tomosynthesis? This entails translating criteria and visualisations of pathologies from the axial plane of CT to coronal orientation of tomosynthesis images. To study this, we have conceptualised Brody's score as a "token" in order to follow its path through and as part of the team's interdisciplinary working, and to identify critical moments where a shift in the development process has occurred. The paper reports two such shifts focussing on how division of lungs into analytic units was repeatedly re-negotiated in order to transpose the scoring system between the different technologies.

Paper long abstract:

In the UK, practitioners in the National Health Service (the NHS) are increasingly subject to the requirements of performance targets and measures. In the area of mental health, these align with a larger policy focus on increasing patient access to psychological therapies. However, an increase in the expected numbers of patients being treated has not been matched with increased resources (other than in particular specialist services). In this paper, drawing on 40 interviews with clinical psychologists working in a range of settings across England and Scotland, I consider professional responses to new performance targets and measures. Departing from a conventionally evaluative idiom (i.e., are targets being met?), I consider targets as a kind of 'technology', enabling and propelling sociotechnical change within NHS organizations. This paper thus contributes to STS debates around the transformative effects of innovations, the governance of (health)care, and the links between epistemic practices and processes of subjectification. Specifically, it asks: what is it that targets do? I document three key effects. First, the production of anxiety about failures to meet targets, changing psychologists' relations with their work and hence with their patients. Second, the development and implementation of novel managerialist frameworks for assessing patient need and processing demand. Third, and most profoundly, the accommodation of performance measures into clinical practice in ways that rework the nature of therapy. This transforms the content and meaning of care practices in order to meet targets - and hence reshapes the kinds of subjectivities that are assembled through therapy.

Paper long abstract:

This paper examines the social imaginaries associated with production and consumption of drugs for cognitive enhancement in the area of work/professional practice. For some time now there has been a plethora of media reports concerning the unofficial/off-label use of drugs (e.g. modafinil) by business people, academics and students. Whilst the efficacy and risks associated with such usage remain controversial, cognitive enhancement has become the object of scientific inquiry as well as ongoing ethical debate, with the potential for enhancement in the workplace also coming under the spotlight. Drugs for cognitive enhancement are seen as offering the prospect of solutions for various problems of performance in employment - ranging from the maintenance of performance on tasks under conditions of physical/mental stress (e.g. long/complex surgical procedures; long shifts in transportation; or military personnel in demanding combat situations); to the enhancement of individuals' cognition so as to enable them to perform tasks from which they would otherwise be excluded in the labour market.

Regarding the conference theme of 'situating solidarities', the notion of co-production in relation to the use of cognitive enhancers begs some difficult questions about the governance of technology; not least because in the context of the employment relationship work is characterised by various asymmetries of power/knowledge between employer and employee. Indeed, the prospect of enhancement sits uneasily alongside existing managerial control measures and testing regimes that seek to govern employees' cognitive performance in respect of sleep/rest work patterns or the consumption of legal and illegal drugs.

Paper long abstract:

This presentation discusses the way in which new health or lifestyle products, such as health foods, mobile health 'apps' and online diagnostic tests, challenge current evidence-based medicine. Drawing on Jewson's and Armstrong's classical notions of medicine, I suggest that the lifestyle products contest classical notions of health and illness in their marketing strategies, the way in which they configure their customers and in the regulatory realm. The marketing of the new products challenge the evidence-based notion of health and illness, frequently presenting hedged claims based on speculative evidence and user commentaries. Lifestyle products also do not configure their customers as passive patients, riddled with anxiety, but as co-creators of products and services, driven not only by health concerns but also pleasure. These novel conceptions of health and illness, fuelled by consumer culture and digital media, frequently end up at loggerheads with evidence-based traditional notions in the regulatory realm. To illustrate the differences and struggles between classical evidence based medicine and the push to 'lifestylise' medicine I will discuss the case of the online genetic testing company 23andMe, whose 'whole genome' test dominated the market until the Food and Drug Administration (FDA) banned it in November 2013.

Paper long abstract:

Nowadays diagnostic innovations, such as point-of-care and lab-on-a-chip technology, are evolving at high pace within the healthcare arena. At the same time, both public and private actors must early anticipate on the grand societal challenges such as globalization, ageing, individualization and personalization of health, care and diagnostics. Diagnostic innovation, therefore, could be perceived as a co-evolutionary process, an institutional interplay in which many stakeholders interact in complex ways. Interactions between users, patients and developers of diagnostic technologies take place both in laboratory and clinic, and in the wider society where the application of diagnostic innovations not only meets a medical need, but is also accompanied by increased health awareness and increased diagnostic needs and values of citizens due to increasing (early) diagnostic possibilities. Heterogeneous stakeholders in society provide feedback about how a new diagnostic technology, with still a high degree of uncertainty about measuring specific functions, technical specifications and related social, cultural and ethical aspects, matches their needs, preferences and performance criteria. It is therefore interesting to understand how the transition towards responsible diagnostic innovation proceeds. In other words, this paper studies potential scenarios of responsible future diagnostic innovations in the Netherlands. This will be done by using the Multi-Level Perspective, taking into account the dynamics of emerging diagnostic technologies and various transition pathways. The study is based on literature search and semi-structured interviews with experts in the Dutch diagnostic field.