Paper long abstract:

Considered the gold standard of evidence-based research, the methodology of

Randomized Controlled Trial (RCT) is the procedure par excellence for establishing whether a particular medical or health intervention is safe and efficacious. To do so, the intervention must be isolated from other coexisting factors on the basis of which it can be statistically evaluated. If it is found 'efficacious' by the RCT, social scientists may then be enlisted to address challenges by co-existing factors to the 'everyday life' effectiveness of the intervention. Thus the distinction between 'efficacy' and 'effectiveness' upon which RCTs rest, makes available a specific centre-periphery mode of multidisciplinarity. By focusing on a case study of conflicting results generated by four multi-site RCTs which found an HIV prevention pill to be efficacious in men but only in some women and attributed to dosing failure by those in which it did not work, we review the way in which the RCT notion of 'efficacy' creates a disciplinary boundary and a particular understanding of what it means for a pill to 'work'. Although the constraints generated by this epistemological approach provide statistically significant data from which to take guidance, the disciplinary boundary itself delimits and, indeed, may be argued to skew the nature of this guidance. Drawing on the work of Francois Jullien, Isabelle Stengers, A.N. Whitehead and pragmatists, William James and John Dewey, we propose a reconstruction of the concept of 'efficacy' mindful of the centre-periphery mode and constitutive of new possibilities that may come from interdisciplinary collaboration and engagement.