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Cancer on Trial: Oncology as a New Style of Practice

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Cancer on Trial: Oncology as a New Style of Practice Cover

 

Synopses & Reviews

Publisher Comments:

Until the early 1960s, cancer treatment consisted primarily of surgery and radiation therapy. Most practitioners then viewed the treatment of terminally ill cancer patients with heroic courses of chemotherapy as highly questionable. The randomized clinical trials that today sustain modern oncology were relatively rare and prompted stiff opposition from physicians, who were loath to assign patients randomly to competing treatments. Yet today these trials form the basis of medical oncology. How did such a spectacular change occur? How did medical oncology pivot from a nonentity and, in some regards, a reviled practice to the central position it now occupies in modern medicine?

and#160;and#160;and#160;and#160;and#160;and#160;and#160;and#160;and#160;and#160;and#160;

In Cancer on Trial Peter Keating and Alberto Cambrosio explore how practitioners established a new style of practice, at the center of which lies the cancer clinical trial. Far from mere testing devices, these trials have become full-fledged experiments that have redefined the practices of clinicians, statisticians, and biologists. Keating and Cambrosio investigate these trials and how they have changed since the 1960s, all the while demonstrating their significant impact on the progression of oncology. A novel look at the institution of clinical cancer research and therapy, this book will be warmly welcomed by historians, sociologists, and anthropologists of science and medicine, as well as clinicians and researchers in the cancer field.

Synopsis:

There were no medical oncologists until a few decades ago. In the early 1960s, not only were there no such specialists, many practitioners regarded the treatment of terminally-ill cancer patients with heroic courses of chemotherapy as highly questionable. Physicians loath to assign patients randomly to competing treatments also expressed their outright opposition to the randomized clinical trials that were then relatively rare. And yet today these trials form the basis of medical oncology. How did such a spectacular change occur? How did medical oncology move from a non-entity and in some regards a reviled practice to the central position it now occupies in modern medicine?and#160;Cancer on Trialand#160;answers these questions by exploring how practitioners established a new style of practice, at the center of which lies the cancer clinical trial.

About the Author

Peter Keating is professor of history at the Universitandeacute; du Quandeacute;bec andagrave; Montrandeacute;al.

Alberto Cambrosio is professor in the Department of Social Studies of Medicine at McGill University. Together, they are the authors of Exquisite Specificity: The Monoclonal Antibody Revolution and Biomedical Platforms: Realigning the Normal and the Pathological in Late Twentieth-Century Medicine.

Table of Contents

Acknowledgments

Introduction

CHAPTER 1. From and#8220;Nonentityand#8221; to Global Network: The Rise of a New Style of Biomedical Practice

An Early Career in Clinical Oncology

About This Book

A Capsule History of Cancer Clinical Trials

Cancer Clinical Trials as a New Style of Practice

The Protocol

Conclusion

PRELUDE. Before There Were Trials

Cancer Hospitals and Cancer Institutes

Diagnosing Cancer

Treating Cancer

Prognosticating Cancer

Testing Therapies

Conclusion

PART 1. The Emergence of Clinical Cancer Research (1955and#8211;66)

CHAPTER 2. A Landmark Clinical Trial

Curing Leukemia: The VAMP Trial

A Collective Undertaking

The Elements of Innovation

What about the Patients?

CHAPTER 3. The Collective Turn: Cooperative Groups as Epistemic Organizations

Assembling the US Cooperative System

Screening for Drugs: From Mice to Humans

Tinkering with the Cooperative Group Structure

Meanwhile in Europe . . .

Conclusion

FIRST INTERLUDE. Clinical Trial Statistics

What Is a Random Sample?

What Is Statistical Significance?

CHAPTER 4. Statisticians, Statistics, and Early Cooperative Clinical Trials

Statisticians at the NIH

Statisticians in Paris

Fabricating the Tools of the Trade

Controversial Methods

The Emergence of the Phase System

Conclusion

CHAPTER 5. Criticism and the Redefinition of Clinical Cancer Trials as an Autonomous Form of Research

Clinical Cancer Research under Fire

The Reorganization of Screening and Clinical Trials in the United States

Surgery and Radiotherapy in the Cooperative Groups

PART 2. An Avalanche of Numbers from the New Style of Practice (1965and#8211;89)

CHAPTER 6. A Web of Trials

Breast Cancer and Its Trials

The Lessons of the Breast Cancer Trials

The Emergence of Combination Chemotherapy

The Multiple Meanings of Breast Cancer Trials

Conclusion

CHAPTER 7. Statisticians, Data Centers, and the Organization of Large-Scale Clinical Trials

Centers of Calculation: US Statisticians and the Data Center

The Mechanics of Data Production

Meanwhile in Europe, Take Two

Back in the USA: Group Statisticians and NCI Statisticians

Insidersand#8217; Dissent: The Randomization Debate

CHAPTER 8. A Relational Space of Substances and Regimens

The Clinical Evaluation of Substances

Screening Substances: The Animal Screen

Procuring Compounds

CHAPTER 9. Oncopolitics? Reshaping Collaborative Research

Centralization or Coordination? The European Debate

Clinical Trials as Clinical Research: The US Debate

Oncology in the Community

PART 3. Targeted Therapy, Targeted Trials (1990and#8211;2006)

SECOND INTERLUDE. Molecular Biology and Oncogenes

Introduction

The Rise of Molecular Biology

Cancer and Molecular Biology: 1960and#8211;80

The Clinical Isolation of Human Oncogenes

Oncogenes and Oncoproteins since 1982

CHAPTER 10. Magic Bullets? The Gleevec Trials

Molecular Biology and Targeted Substances

The Trials of a Targeted Therapy

Where Did Gleevec Come From?

Monitoring Data, Managing Risks

A Medical Oncologist and His Patients

Patients and Activists

Conclusion

CHAPTER 11. Targeted Therapy and Clinical Cancer Research

Introduction: Molecular Biology and Translational Research

Molecular Biology and the US Cooperative Groups

The Reorganization of the Drug Discovery Process and the Transformation of the NCI Screen

Clinical Trials in a Targeted Age

More Oncopolitics

Conclusion

Conclusion

CHAPTER 12. Looking Back and Looking Forward

The Observational Alternative to Clinical Cancer Trials

Comparative Effectiveness and Clinical Trials

Coda

References

Index

Product Details

ISBN:
9780226428918
Author:
Keating, Peter
Publisher:
University of Chicago Press
Author:
Cambrosio, Alberto
Subject:
Oncology
Subject:
History of Science-General
Subject:
Health and Medicine-Medical Specialties
Edition Description:
Hardcover
Publication Date:
20120231
Binding:
HARDCOVER
Language:
English
Illustrations:
24 halftones, 28 line drawings
Pages:
424
Dimensions:
9 x 6 in

Related Subjects

Health and Self-Help » Health and Medicine » Cancer
Health and Self-Help » Health and Medicine » History of Medicine
Health and Self-Help » Health and Medicine » Medical Specialties
Health and Self-Help » Health and Medicine » Professional Medical Reference
Science and Mathematics » History of Science » General

Cancer on Trial: Oncology as a New Style of Practice New Hardcover
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Product details 424 pages University of Chicago Press - English 9780226428918 Reviews:
"Synopsis" by ,
There were no medical oncologists until a few decades ago. In the early 1960s, not only were there no such specialists, many practitioners regarded the treatment of terminally-ill cancer patients with heroic courses of chemotherapy as highly questionable. Physicians loath to assign patients randomly to competing treatments also expressed their outright opposition to the randomized clinical trials that were then relatively rare. And yet today these trials form the basis of medical oncology. How did such a spectacular change occur? How did medical oncology move from a non-entity and in some regards a reviled practice to the central position it now occupies in modern medicine?and#160;Cancer on Trialand#160;answers these questions by exploring how practitioners established a new style of practice, at the center of which lies the cancer clinical trial.
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