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  • WEISZ Georges (2)
  • KNAAPEN Loes (2)
  • COINTET Jean-Philippe (2)
  • CASTEL Patrick (2)
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  • Article (4)
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This paper analyses the developmental dynamics of oncology research in Portugal during the second half of the twentieth century and early twenty first century. Grounding its conclusions in a scientometric analysis of a database of publications covering the period 1976–2015, the paper shows how the expansion of oncology research from the end of the 1990s through the 2000s is closely related to science and technology policy decisions in the country. The main actors of the institutional evolution of the field are public organizations, both hospital and academia/research-based, frequently working together. Portuguese oncology research focused especially on organ-based cancers, underlining the strong link between the laboratory and the clinic. Accordingly, translational research is a major trend in oncology research, as evidenced by the analysis of publications in major journals and inter-citation maps. Net...

in The Milbank quarterly Publié en 2007
WEISZ Georges
KEATING Peter
KNAAPEN Loes
SCHILCH Thomas
TOURNAY Virginie
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Clinical practice guidelines are now ubiquitous. This article describes the emergence of such guidelines in a way that differs from the two dominant explanations, one focusing on administrative cost-cutting and the other on the need to protect collective professional autonomy. Instead, this article argues that the spread of guidelines represents a new regulation of medical care resulting from a confluence of circumstances that mobilized many different groups. Although the regulation of quality has traditionally been based on the standardization of professional credentials, since the 1960s it has intensified and been supplemented by efforts to standardize the use of medical procedures. This shift is related to the spread of standardization within medicine and especially in research, public health, and large bureaucratic health care organizations.

This paper examines one of the most visible but oddly neglected aspects of the rapidly expanding Global Health (GH) enterprise: its vast literature. Basing our data on the PubMed MeSH term “World Health” (changed to “Global Health” in 2015) and utilizing the citation and funding metadata provided by Web of Science, we analyze nearly 20,000 articles using the software platform CorTexT for the automatic processing of large text corpora. We perform several types of scientometric network analyses, and provide maps displaying inter-citations among journals publishing GH articles, co-authorship among the 292 authors who published 12 or more papers, co-citation analysis of works (articles, books, and reports) cited at least 30 times by the papers in our database, and funding sources since 2008. The maps display the social, cognitive, and funding substructure of the GH publication field. We suggest that this somewhat fragmented and fuzzy domain is held together by (1) a core group of authors who have for some time been co-authoring numerous papers and reports with one another; (2) several central journals, most notably the Lancet, addressing wider audiences and transcending the narrow specialization characteristic of scientific and biomedical fields; and (3) a growing body of large-data metrics, most prominently the Global Burden of Disease, which has become a rhetorical resource for numerous groups with different agendas.

In this paper, we focus on the study of six multi-center genomic trials, promoted by four different French cancer centers. Following recent work that investigated the organizational dimensions of biomedical innovations, we explore the “mutually constitutive relation between epistemic and organizational innovation” (Cambrosio, Keating & Nelson, 2014, p.13) in the domain of “precision medicine”. As a matter of fact, one may observe a great diversity of genomic trials regarding their scientific as well as their organizational design. We show that, in our case, the relations between organization/ing and experimentation/ing are manifold and, in fact, may be framed as cascading experimentations. First, the genomic clinical trials under investigation may be conceptualized as instances of experimenting (temporary) organization, since the organizational design that accompanies their deployment has changed over time in order to adapt to emerging problems. Second, these trials (are meant to) challenge and change the functioning of the healthcare organizations within which they are deployed. Reciprocally, the functioning of healthcare organizations enables and constrains the trials’ design as well as their successful completion. Fundamentally, these trials must be analyzed as epistemic as well as organizational innovation.

in Social science & medicine Publié en 2010-08
KNAAPEN Loes
CAZENEUVE Hervé
FERVERS Béatrice
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Both critics and supporters of Evidence-Based Medicine view Clinical Practice Guidelines as an important component of this self-defined “new paradigm” whose goal is to rationalize medicine by grounding clinical decision-making in a careful assessment of the medical literature. We present an analysis of the debates within a Guideline Development Group (GDG) that lead to the drafting, revision and publication of a French cancer guideline. Our ethnographic approach focuses on the various aspects of the dispositif (or apparatus) that defines the nature and roles of participants, procedures, topics and resources within the GDG. Debates between GDG members are framed (but not dictated) by procedural and methodological rules as well as by the reflexive critical contributions of the GDG members themselves, who justify their (tentative) recommendations by relating to its (possible or intended) audiences. Guideline production work cannot be reduced to an exchange of arguments and to consensus-seeking between pre-defined professional interests. It is about the production of a text in the material sense of the term, i.e., as a set of sentences, paragraphs, statements and formulations that GDG members constantly readjust and rearrange until closure is met. As such, guidelines partake in the emergence and stabilization of a new configuration of biomedical knowledge and practices grounded in the establishment of mutually constitutive links between two processes: on the one hand, the re-formatting of clinical trials into a device for producing carefully monitored evidence statements targeting specific populations and clinical indications and, on the other hand, the increasingly pervasive role of regulatory processes.