The Alchemy of Clinical Trials

It is argued that trials in the field of cardiovascular disease prevention are constituted as ‘research’ rather than ‘science’, which means that trials are more like alchemy than assay, proceeding by complex moves to transform ‘base’ matters rather than distilling elements of clinical practice.

Abstract

This article considers the complex construction of randomized controlled trials that lies behind the rhetoric of the gold standard. Drawing on insights from Science and Technology Studies and empirical material, I argue that trials in the field of cardiovascular disease prevention are constituted as 'research' rather than 'science'. In these examples, control emerges out of a dual concern with practices of purification and involvement of aspects of the world outside the experiment, as the designers of trials aspire to relevance as well as rigour. Such strategies of 'contextualization' mean that trials are more like alchemy than assay, proceeding by complex moves to transform 'base' matters rather than distilling elements of clinical practice.