Evidence-based medicine from a social science perspective

Background: Since the emergence of evidencebased medicine (EBM) in the 1980s, social scientists ­ including historians, sociologists, anthropologists, political scientists and philosophers ­ have attempted to reckon with the movement's origins, implications and consequences. Objectives: This paper reviews the social science literature related to EBM and attempts to draw some conclusions for the future improvement of EBM. Discussion: The paper divides the discussion of evidence-based into three critiques: the 'statistics' critique, the 'cookbook' critique and the 'neo-liberal' critique. Incorporating social sciences approaches into clinical education and clinical research will be critical to the future development and success of EBM.

Globalizing Genomics: The Origins of the International Nucleotide Sequence Database Collaboration.

Genomics is increasingly considered a global enterprise - the fact that biological information can flow rapidly around the planet is taken to be important to what genomics is and what it can achieve. However, the large-scale international circulation of nucleotide sequence information did not begin with the Human Genome Project. Efforts to formalize and institutionalize the circulation of sequence information emerged concurrently with the development of centralized facilities for collecting that information. That is, the very first databases build for collecting and sharing DNA sequence information were, from their outset, international collaborative enterprises. This paper describes the origins of the International Nucleotide Sequence Database Collaboration between GenBank in the United States, the European Molecular Biology Laboratory Databank, and the DNA Database of Japan. The technical and social groundwork for the international exchange of nucleotide sequences created the conditions of possibility for imagining nucleotide sequences (and subsequently genomes) as a "global" objects. The "transnationalism" of nucleotide sequence was critical to their ontology - what DNA sequences came to be during the Human Genome Project was deeply influenced by international exchange.

From medical gaze to statistical person: Historical reflections on evidence-based and personalised medicine.

BACKGROUND: The nineteenth century saw the rise of what historians of medicine have termed the 'medical gaze'. Physicians used instrumentation and trained senses to locate the site of disease within the patient's body. This change in practice went alongside changes in the physician's power and how diseases were understood. In the twenty-first century, the rise of high-throughput biomedical experiments, especially in genomics, is leading to equally dramatic shifts in medicine. Increasingly, clinical decisions may be made on the basis of data and statistical associations rather than the particularities of the case at hand. OBJECTIVE: The aim of this commentary iso re-evaluate the status of precision and evidence-based medicine in light of the social, political and economic shifts they entail. DISCUSSION: Increasingly, the statistical view of diseases and people threatens to take judgment and expertise out of medical decision making. It threatens the centrality of the physician in the relationship between patient and disease.

Bermuda 2.0: reflections from Santa Cruz.

In February 1996, the genome community met in Bermuda to formulate principles for circulating genomic data. Although it is now 20 years since the Bermuda Principles were formulated, they continue to play a central role in shaping genomic and data-sharing practices. However, since 1996, "openness" has become an increasingly complex issue. This commentary seeks to articulate three core challenges data-sharing faces today.

Networking Biology: The Origins of Sequence-Sharing Practices in Genomics.

The wide sharing of biological data, especially nucleotide sequences, is now considered to be a key feature of genomics. Historians and sociologists have attempted to account for the rise of this sharing by pointing to precedents in model organism communities and in natural history. This article supplements these approaches by examining the role that electronic networking technologies played in generating the specific forms of sharing that emerged in genomics. The links between early computer users at the Stanford Artificial Intelligence Laboratory in the 1960s, biologists using local computer networks in the 1970s, and GenBank in the 1980s, show how networking technologies carried particular practices of communication, circulation, and data distribution from computing into biology. In particular, networking practices helped to transform sequences themselves into objects that had value as a community resource.

High-throughput ectopic expression screen for tamoxifen resistance identifies an atypical kinase that blocks autophagy.

Resistance to tamoxifen in breast cancer patients is a serious therapeutic problem and major efforts are underway to understand underlying mechanisms. Resistance can be either intrinsic or acquired. We derived a series of subcloned MCF7 cell lines that were either highly sensitive or naturally resistant to tamoxifen and studied the factors that lead to drug resistance. Gene-expression studies revealed a signature of 67 genes that differentially respond to tamoxifen in sensitive vs. resistant subclones, which also predicts disease-free survival in tamoxifen-treated patients. High-throughput cell-based screens, in which >500 human kinases were independently ectopically expressed, identified 31 kinases that conferred drug resistance on sensitive cells. One of these, HSPB8, was also in the expression signature and, by itself, predicted poor clinical outcome in one cohort of patients. Further studies revealed that HSPB8 protected MCF7 cells from tamoxifen and blocked autophagy. Moreover, silencing HSBP8 induced autophagy and caused cell death. Tamoxifen itself induced autophagy in sensitive cells but not in resistant ones, and tamoxifen-resistant cells were sensitive to the induction of autophagy by other drugs. These results may point to an important role for autophagy in the sensitivity to tamoxifen.

Effects of degassing on the long-range attractive force between hydrophobic surfaces in water.

The long-ranged attractions between hydrophobic amorphous fluoropolymer surfaces are measured in water with and without dissolved air. An atomic force microscope is used to obtain more than 500 measured jump-in distances, which yields statistically reliable results. It is found that the range of the attraction and its variability is generally significantly decreased in deaerated water as compared to normal, aerated water. However, the range and strength of the attraction in deaerated water remain significantly greater than the van der Waals attraction for this system. The experimental observations are consistent with (1) nanobubbles being primarily responsible for the long-ranged attraction in normal water, (2) nanobubbles not being present in deaerated water when the surfaces are not in contact, and (3) the attraction in the absence of nanobubbles being most probably due to the approach to the separation-induced spinodal cavitation of the type identified by Bérard et al. [J. Chem. Phys. 1993, 98, 7236]. It is argued that the measurements in deaerated water reveal the bare or pristine hydrophobic attraction unobscured by nanobubbles.