Objetividad regulatoria y sistemas de pruebas en medicina: el caso de la cancerología
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sep 1, 2006
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Resumen
La evolución de la medicina occidental desde la Segunda Guerra Mundial ha resultado en la emergencia de nuevas prácticas basadas en la interacción directa entre biología y medicina. El realineamiento de la biología y medicina de la posguerra ha sido acompañada de la emergencia de un nuevo tipo de objetividad, objetividad regulatoria, que ha sido sustentada sobre el recurso a la producción colectiva de la evidencia. A diferencia de las formas de objetividad que emergieron en épocas tempranas, la objetividad regulatoria repercute de manera consistente en la producción de convenciones, algunas veces tácitas y sin intencionalidad, pero frecuentemente arriba a través de programas concertados de acción. Las convenciones producidas por la objetividad regulatoria crean las condiciones para una objetividad clínica, que confía en la existencia de entidades y protocolos creados y mantenidos fuera del encuentro íntimo en tre doctor y paciente. Estableciendo formas endógenas de regulación, la objetividad reguladora funciona en un plano y en un modo diferente de aquellos sugeridos por los analistas que tratan toda la regulación como una forma de racionalización impuesta sobre la medicina de fuera.
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CAMBROSIO, Alberto; KEATING, Peter; BOURRET, Pascale.
Objetividad regulatoria y sistemas de pruebas en medicina: el caso de la cancerología.
Convergencia Revista de Ciencias Sociales, [S.l.], n. 42, sep. 2006.
ISSN 2448-5799.
Disponible en: <https://convergencia.uaemex.mx/article/view/1398>. Fecha de acceso: 06 feb. 2023
Palabras clave
biomedicina; objetividad; regulación; evidencia; convenciones
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Citas
AGREE Collaborative Group (2000), “Guideline development in
Europe. An international comparison”, en International journal of
technology assessment in health care, vol. 16.
Baird, Davis (2004), Thing knowledge: a philosophy of scientific instruments,
Berkeley, CA: University of California Press.
Berg, Marc (1996), “Practices of reading and writing. The constitutive
role of the patient record in medical work”, en Sociology of health and
illness, 18.
Berg, Marc y Annemarie Mol [eds.] (1998), Differences in medicine.
Unraveling practices, techniques and bodies, Durham: Duke University Press.
Berg, Marc et al. (2000), “Guidelines, professionals and the production of
objectivity. Standardisation and the professionalisation of insurance
medicine”, en Sociology of health and illness, 22.
Berlivet, Luc (1999), “Argumentation scientifique et espace publique. La
quête de l’objectivité dans les controversies autour des ‘risques de
santé’”, en François, Bastien y Erik Neveu [eds.], Espaces publics
mosaïques. Acteurs, arènes et rhétoriques des débats publics contemporains, Rennes: Presses Universitaires de Rennes.
Bodewitz, Henk et al. (1987), “Regulatory science and the social
management of trust in medicine”, en Bijker, Wiebe et al. [eds.], The
social construction of technological systems, Cambridge, MA: MIT Press.
Bourret, Paul (2005), “BRCA Patients and clinical collectives: new
configurations of action in cancer genetics practices”, en Social studies of
science, vol. 35.
Bourret, Paul et al. (2006), “A new clinical collective for french cancer
genetics: a heterogeneous mapping analysis”, en Science, technology &
human values, vol. 31.
Burgers, Jako et al. [for the AGREE Collaboration] (2003), “Towards
evidence-based clinical practice: an international survey of 18 clinical
guideline programs”, en International journal for quality in health care, vol.
15.
Cambrosio, Alberto (2004), “Mapping collaborative work and innovation
in biomedicine: a computer-assisted analysis of antibody reagent
workshops”, en Social studies of science, vol. 34.
Cambrosio, Alberto et al. (2006), “Regulatory objectivity and the
generation and management of evidence in medicine”, en Social science
& medicine, 63.
_______, “A paraître. Mapping the emergence and development of
translational cancer research”, en European journal of cancer (en prensa).
Canguilhem, Georges (1972), Le normal et le pathologique, Paris: Presses
Universitaires de France.
Castel, Patrick y Ivanne Merle (2002), “Quand les normes de pratiques
deviennent une ressource pour les medecins”, en Sociologie du Travail,
vol. 44.
Casper, Mónica y Adele Clarke (1998), “Making the pap smear into the
‘right tool’ for the job: cervical cancer screening in the USA, Circa
1940-95”, en Social studies of science, vol. 28.
Christian, Michaele et al. (2002), “A central institutional review board for
multi-institutional trials”, en New England journal of medicine, vol. 346.
Daly, J. (2005), Evidence-based medicine and the search for a science of clinical care, Berkeley, CA: University of California Press.
Daston, Lorraine (1992), “Objectivity and the escape from perspectiva”,
en Social studies of science, vol. 22.
Daston, Lorraine y Peter Galison (1992), “The image of objectivity”, en
Representations, vol. 40.
Ferguson, John y Charles Sherman (2001), “Panelists’ views of 68 NIH
Consensus conferences”, en International journal of technology assessment in health care, vol. 17.
Galison, Peter (1998), “Judgment against objectivity”, en Jones, C. y P.
Galison [eds.], Picturing science, producing art, New York: Routledge.
Gaudillière, Jean y Hans Rheinberger [eds.] (2004), From molecular genetics to genomics. The mapping cultures of twentieth-century genetics, London: Routledge.
Hafferty, F. y D. Light (1995), “Professional dynamics and the changing
nature of medical work”, en Journal of health and social behavior, núm. 35
[Extra issue: Forty years of medical sociology].
Howell, Joel (1995), Technology in the hospital. Transforming patient care in the early twentieth century, Baltimore: The Johns Hopkins University Press.
Kaufert, Patricia (2000), “Screening the body: the pap smear and the
mammogram”, en Lock, Margaret et al. [eds.], Living and working with the
new medical technologies: intersections of inquiry, Cambridge, UK: Cambridge University Press.
Keating Peter y Alberto Cambrosio (2005), “The production of
biomedical measures: three platforms for quantifying cancer
pathology”, en Jorland, Gérard et al. [eds.], Body counts: medical
quantification in historical and sociological perspectives, Montreal:
McGill-Queen’s University Press.
_______ (1998), “Interlaboratory life: regulating flow cytometry”, en
Gaudillière, J. e I. Löwy [eds.], The invisible industrialist: manufacturers and
the construction of scientific knowledge, London: Macmillan; New York: St.
Martin’s Press.
_______ (2000), “Real compared to what?: diagnosing leukemias and
lymphomas”, en Lock, M. et al. [eds.], Living and working with the new
medical technologies. Intersections of inquirí, Cambridge: Cambridge
University Press.
_______ (2003), Biomedical platforms. Realigning the normal and the pathological in late-twentieth-century medicine, Cambridge, MA: MIT Press.
_______ (2004), “Does biomedicine entail the successful reduction of
pathology to biology?”, en Perspectives in biology and medicine, vol. 47.
Meunier, F. y A. van Oosterom (2002), “40 years of the EORTC: The
evolution towards a unique network to develop new standards of
cancer care”, en European journal of cancer, vol. 38 (Suppl. 4).
Mossé, Philippe (1998), “La rationalisation des pratiques médicales.
Entre efficacité et effectivité”, en Sciences sociales et santé vol. 16, núm. 4.
O’Connell, Joseph (1993), “Metrology: the creation of universality by the
circulation of particulars”, en Social studies of science, vol. 23.
Porter, Theordore (1995), Trust in numbers. The pursuit of objectivity in science and public life, Princeton, NJ: Princeton University Press.
Robelet, Magali (1999), “Les médecins placés sous observation.
Mobilisation autour du développement de l’évaluation médicale en
France”, en Politix, vol. 46.
_______ (2001), “La profession médicale face au défi de la qualité. Une
comparaison de quatre manuels qualité”, en Sciences sociales et santé, vol.
19, núm. 2.
Schaffer, Steve (1992), “Late victorian metrology and its instrumentation:
a manufactory of Ohms”, en Bud, R. y S. Cozzens [eds.], Invisible
connections. Instruments, institutions, and science, Bellingham, WA: SPIE
Optical Engineering Press.
Setbon, Michel (2000), “La qualité des soins. Nouveau paradigme de
l’action collective?”, en Sociologie du Travail, vol. 42.
Singleton, Vicky y Mike Michael (1993), “Actor-networks and
ambivalence: general practitioners in the UK Cervical Screening
Programme”, en Social studies of science, vol. 23.
Sournia, Jean (1995), Histoire du diagnostic en médecine, Paris: Éditions de
Santé.
Thévenot, Laurent (1985), “Les investissements de forme”, en Cahiers du
centre d’études de l’emploi, vol. 29.
Timmermans, Stefan y Marc Berg (2003), The gold standard. the challenge of evidence-based medicine and standardization in health care, Philadelphia: Temple University Press.
Tournay, V. (2005), Produire des biens publics médicaux: Contribution
pragmatique à une sociologie de l’action publique, Thèse de doctorat,
Science-Politique, Université de Paris I-Sorbonne.
Willems, Dick (1998), “Outcomes, guidelines and implementation in
France, the Netherlands and Great Britain”, en Boyle, P. [ed.], Getting doctors to listen. The ethics of outcome research in practice, Washington, DC: George Kennedy University Press.
Europe. An international comparison”, en International journal of
technology assessment in health care, vol. 16.
Baird, Davis (2004), Thing knowledge: a philosophy of scientific instruments,
Berkeley, CA: University of California Press.
Berg, Marc (1996), “Practices of reading and writing. The constitutive
role of the patient record in medical work”, en Sociology of health and
illness, 18.
Berg, Marc y Annemarie Mol [eds.] (1998), Differences in medicine.
Unraveling practices, techniques and bodies, Durham: Duke University Press.
Berg, Marc et al. (2000), “Guidelines, professionals and the production of
objectivity. Standardisation and the professionalisation of insurance
medicine”, en Sociology of health and illness, 22.
Berlivet, Luc (1999), “Argumentation scientifique et espace publique. La
quête de l’objectivité dans les controversies autour des ‘risques de
santé’”, en François, Bastien y Erik Neveu [eds.], Espaces publics
mosaïques. Acteurs, arènes et rhétoriques des débats publics contemporains, Rennes: Presses Universitaires de Rennes.
Bodewitz, Henk et al. (1987), “Regulatory science and the social
management of trust in medicine”, en Bijker, Wiebe et al. [eds.], The
social construction of technological systems, Cambridge, MA: MIT Press.
Bourret, Paul (2005), “BRCA Patients and clinical collectives: new
configurations of action in cancer genetics practices”, en Social studies of
science, vol. 35.
Bourret, Paul et al. (2006), “A new clinical collective for french cancer
genetics: a heterogeneous mapping analysis”, en Science, technology &
human values, vol. 31.
Burgers, Jako et al. [for the AGREE Collaboration] (2003), “Towards
evidence-based clinical practice: an international survey of 18 clinical
guideline programs”, en International journal for quality in health care, vol.
15.
Cambrosio, Alberto (2004), “Mapping collaborative work and innovation
in biomedicine: a computer-assisted analysis of antibody reagent
workshops”, en Social studies of science, vol. 34.
Cambrosio, Alberto et al. (2006), “Regulatory objectivity and the
generation and management of evidence in medicine”, en Social science
& medicine, 63.
_______, “A paraître. Mapping the emergence and development of
translational cancer research”, en European journal of cancer (en prensa).
Canguilhem, Georges (1972), Le normal et le pathologique, Paris: Presses
Universitaires de France.
Castel, Patrick y Ivanne Merle (2002), “Quand les normes de pratiques
deviennent une ressource pour les medecins”, en Sociologie du Travail,
vol. 44.
Casper, Mónica y Adele Clarke (1998), “Making the pap smear into the
‘right tool’ for the job: cervical cancer screening in the USA, Circa
1940-95”, en Social studies of science, vol. 28.
Christian, Michaele et al. (2002), “A central institutional review board for
multi-institutional trials”, en New England journal of medicine, vol. 346.
Daly, J. (2005), Evidence-based medicine and the search for a science of clinical care, Berkeley, CA: University of California Press.
Daston, Lorraine (1992), “Objectivity and the escape from perspectiva”,
en Social studies of science, vol. 22.
Daston, Lorraine y Peter Galison (1992), “The image of objectivity”, en
Representations, vol. 40.
Ferguson, John y Charles Sherman (2001), “Panelists’ views of 68 NIH
Consensus conferences”, en International journal of technology assessment in health care, vol. 17.
Galison, Peter (1998), “Judgment against objectivity”, en Jones, C. y P.
Galison [eds.], Picturing science, producing art, New York: Routledge.
Gaudillière, Jean y Hans Rheinberger [eds.] (2004), From molecular genetics to genomics. The mapping cultures of twentieth-century genetics, London: Routledge.
Hafferty, F. y D. Light (1995), “Professional dynamics and the changing
nature of medical work”, en Journal of health and social behavior, núm. 35
[Extra issue: Forty years of medical sociology].
Howell, Joel (1995), Technology in the hospital. Transforming patient care in the early twentieth century, Baltimore: The Johns Hopkins University Press.
Kaufert, Patricia (2000), “Screening the body: the pap smear and the
mammogram”, en Lock, Margaret et al. [eds.], Living and working with the
new medical technologies: intersections of inquiry, Cambridge, UK: Cambridge University Press.
Keating Peter y Alberto Cambrosio (2005), “The production of
biomedical measures: three platforms for quantifying cancer
pathology”, en Jorland, Gérard et al. [eds.], Body counts: medical
quantification in historical and sociological perspectives, Montreal:
McGill-Queen’s University Press.
_______ (1998), “Interlaboratory life: regulating flow cytometry”, en
Gaudillière, J. e I. Löwy [eds.], The invisible industrialist: manufacturers and
the construction of scientific knowledge, London: Macmillan; New York: St.
Martin’s Press.
_______ (2000), “Real compared to what?: diagnosing leukemias and
lymphomas”, en Lock, M. et al. [eds.], Living and working with the new
medical technologies. Intersections of inquirí, Cambridge: Cambridge
University Press.
_______ (2003), Biomedical platforms. Realigning the normal and the pathological in late-twentieth-century medicine, Cambridge, MA: MIT Press.
_______ (2004), “Does biomedicine entail the successful reduction of
pathology to biology?”, en Perspectives in biology and medicine, vol. 47.
Meunier, F. y A. van Oosterom (2002), “40 years of the EORTC: The
evolution towards a unique network to develop new standards of
cancer care”, en European journal of cancer, vol. 38 (Suppl. 4).
Mossé, Philippe (1998), “La rationalisation des pratiques médicales.
Entre efficacité et effectivité”, en Sciences sociales et santé vol. 16, núm. 4.
O’Connell, Joseph (1993), “Metrology: the creation of universality by the
circulation of particulars”, en Social studies of science, vol. 23.
Porter, Theordore (1995), Trust in numbers. The pursuit of objectivity in science and public life, Princeton, NJ: Princeton University Press.
Robelet, Magali (1999), “Les médecins placés sous observation.
Mobilisation autour du développement de l’évaluation médicale en
France”, en Politix, vol. 46.
_______ (2001), “La profession médicale face au défi de la qualité. Une
comparaison de quatre manuels qualité”, en Sciences sociales et santé, vol.
19, núm. 2.
Schaffer, Steve (1992), “Late victorian metrology and its instrumentation:
a manufactory of Ohms”, en Bud, R. y S. Cozzens [eds.], Invisible
connections. Instruments, institutions, and science, Bellingham, WA: SPIE
Optical Engineering Press.
Setbon, Michel (2000), “La qualité des soins. Nouveau paradigme de
l’action collective?”, en Sociologie du Travail, vol. 42.
Singleton, Vicky y Mike Michael (1993), “Actor-networks and
ambivalence: general practitioners in the UK Cervical Screening
Programme”, en Social studies of science, vol. 23.
Sournia, Jean (1995), Histoire du diagnostic en médecine, Paris: Éditions de
Santé.
Thévenot, Laurent (1985), “Les investissements de forme”, en Cahiers du
centre d’études de l’emploi, vol. 29.
Timmermans, Stefan y Marc Berg (2003), The gold standard. the challenge of evidence-based medicine and standardization in health care, Philadelphia: Temple University Press.
Tournay, V. (2005), Produire des biens publics médicaux: Contribution
pragmatique à une sociologie de l’action publique, Thèse de doctorat,
Science-Politique, Université de Paris I-Sorbonne.
Willems, Dick (1998), “Outcomes, guidelines and implementation in
France, the Netherlands and Great Britain”, en Boyle, P. [ed.], Getting doctors to listen. The ethics of outcome research in practice, Washington, DC: George Kennedy University Press.