Science in the Clinic: HIV Research in the Era of Evidence-Based MedicinePublic Deposited
This is a study of the conduct and consumption of statistical medical research HIV/AIDS clinics in the context of the expansion of domestic and international clinical research and evidence-based medicine. Evidence-based medicine is the most recent and most successful attempt at subjecting medical decisions to statistical measurement and control. The dissertation is divided into three substantive sections. The first examines how scientific evidence is defined and valued in formal evidence-based medicine standard of care guidelines to how evidence is produced and judged at the clinic-level. Second, I examine the organizational processes of conducting research and argue that the introduction of new jobs, hierarchies and technologies potentially influence clinical work as much as the subsequent implementation of research results. Finally, I examine how physicians and nurses actually conduct medical statistical research in local settings. Theoretically, this dissertation expands on an emerging sociology of medical science, an area of inquiry that concerns the content of medical scientific knowledge, its underlying modes of reasoning and the processes of medical research. The mandate to produce and use numbers entails more than simply reporting the numbers. Translating material, especially human material, into quantifiable categories is a social process. This dissertation traces how staff working in dispersed locations fit the messy reality of the clinic to the uniform reporting requirements of clinical research and how, in turn, the requirements of research alter the organization of the clinic in ways that ease the production and consumption of research results. In short, this dissertation is about making and using numbers and the rules, procedures, and infrastructure that make quantification possible. The dissertation draws on fieldwork observations and interviews in four HIV clinics in the United States of America, Uganda and South Africa.