S. Scott Graham
University of Wisconsin-Milwaukee
STS, STP, and communication scholars are very familiar with the long-standing problem of inclusion in STEM policy disputes. Recent scholarship in these disciplines has offered multiple and conflicting normative visions for the most ethical and effective models for STEM policy decision-making. Traditionally, this issue has been framed in terms of determining how to include the marginalized voices of non-expert classes, the so-called “laity,” in STEM policy decision-making. And, indeed, the long history of governmental agencies, in concert with technical experts, making policy decisions without public input strongly suggests the need for an increasingly democratic approach to those decisions. When it comes to issues of public health, toxic waste storage, nuclear contaminants, catastrophic climate change, etc, STS, STP, and communication scholars have documented a systematic marginalization of non-expert voices (Gieryn, 1983; Wynne, 1989; Jasanoff, 1990; Peterson and Horton, 1995; Gieryn, 1999; Callon, Lascoumes and Barthe, 2001; Schwarze, 2003; Koerber, 2006; Majdik, 2009, Teston and Graham, 2012). However, recent scholarship citing the detrimental effects of unlimited inclusion in terms of policy outcomes has strongly questioned the value of equality of access as the primary criterion for the constitution of STEM policy decision-making bodies (Collins and Evans, 2002; Latour, 2004; Latour, 2009, Ceccarelli, 2011). In short, the literature is deeply conflicted over the appropriate role of industry in STEM policy decision-making. Are industry representatives a locus of duplicity borne of financial interest or are they experienced-based experts whose insights should be an essential part of STEM policy deliberation?
Despite the popularity of each of these normative visions, there are no comparative, evidence-based investigations of both models in action. Subsequently, this project offers one potential option for escaping this theoretical morass. The FDA’s Drug Advisory Committee Program is ideal for investigation, because it has been a long-standing venue for STEM policy decision-making that also incorporates systematic approaches to both 1) non-expert stakeholder inclusion and 2) conflict of interest management strategies.
The results of this pilot study will offer insights into effective mixed-methodological approaches for evaluating the extent and nature of the influences of non-expert stakeholder inclusion and conflicted member inclusion on Drug Advisory Committee deliberation and decision-making. Specifically, the research team is conducting a multi-axial assessment of various influences (e.g., non-expert stakeholder inclusion, conflicted stakeholder inclusion, distribution of evidence, forms of argument) on a variety of outcomes (e.g., policy recommendations, voting distributions, and voting justification statements). This multi-axial assessment allows for subsequent data triangulation, thereby increasing the reliability of the final results and providing insight into a range of possible influences on the Drug Advisory deliberation and decision-making process, including:
- Does the inclusion of more non-expert stakeholders change the nature of evidence presented at Drug Advisory Committee meetings?
- Does the presence or length of a public comment section impact the distribution of votes at the end of the meeting?
- Does the inclusion of committee members with industry conflicts impact the final distribution of votes on Advisory Committee recommendations?
- Do changes in the distribution of evidence and forms of reasoning in drug sponsor presentations impact final policy recommendations?
Key words to describe work
Medical Science, pharmaceuticals policy, continuing medical education, mixed-methods, science and technology studies
work in relation to symposium keywords
The words that relate most to my work are methods and theory.
I have always been committed to data-driven theory. I think that cultural studies and STS have a great deal of insight to offer into the form and function of medical science and the medical-industrial complex. However, these theoretical agendas come with predictive theses (total hegemony, strong incommensurability, etc) that are not always borne out in specific datasets. Mixed-methodological assessments of large medical networks/ontologies are necessary both to validate existing theory and to build new insights.
- How do you explain/define what you do to medical personnel and/or other stakeholders in the research process or to the public?
I describe myself as a methodologist with expertise in “the other half” of mixed-methods research. Specifically, I suggest that we have the tools and techniques (qualitative interviews, content analysis, interviews, etc) to capture the forms of data that elude clinical trials and biomechanical research (patient-reported outcomes, policy outcomes, dissemination, etc).
- How would you describe the relationship between medical rhetoric/health communication (however you see yourself) with other fields and sub-fields (e.g., rhetoric of science)? For example, we struggled with what to name the symposium. Some suggested medical rhetoric, but that doesn’t comfortably fit some from Communication nor from English Studies. In other words, how do you align what may be a specific focus with broader disciplinary concerns and tensions?
I think there are rhetoricians of science, rhetoricians of health, technical communication scholars, and health communication scholars. Each of these areas are viable disciplines/sub-disciplines with extant scholarly traditions, methods, and research questions. However, I think a rhetorician of science that studies clinical trials has more in common with a rhetorician of science that studies high energy physics than s/he does with a health communication scholar. The two rhetoricians share a disciplinary training, a set of methodologies, and a common scholarly conversation. The rhetorician and the health comm scholar may not share more than the site of inquiry. (I wonder if the anthropologist of science who studies biology and the sociologist of science who also studies biology are concerned with coming up with an umbrella term for “anthrosociology of biology.”)
All that being said, I think this is a good thing. Our shared interests in health and medicine as sites of inquiry make for a fantastic opportunity for interdisciplinary collaboration. I’m working on collaborative projects with another rhetorician of science, a health communication scholar, and a public health scholar. We each bring radically different approaches to the table and our work is only better for it.
- What do you see as the primary distinctions between a “humanities” orientation to research and a “social sciences” orientation? what is at stake in these different orientations?
1) I had to add cultural studies, because even though it often lives in “humanities” departments, I would argue that it is (often) distinctly anti-humanistic.
2) Given the length of the following, I can’t avoid broad brush strokes—obviously many individual scholars who identify with each tradition are able to avoid one or more of its challenges.
|Humanities||Deep understanding of exemplar communication artifacts. Interpretive flexibility.||Voluntarist theories of agency. Thin theory. Often blind to materiality. Occasional statistiphobia.|
|Social Sciences||Robust research methodologies. Breadth of analysis. Socio-cultural capital (claim making, grant funding).||When n=many, deep conclusions about n=1 are often a challenge. Occasional difficulty in making normative claims. (Useful) fictions of objectivity.|
|Cultural Studies||Thick theory. Robust framework for addressing materiality and agency. Can be deployed for both broad and deep analyses.||Lack of socio-cultural capital (gadfly reputation). Dense theoretical vocabulary often alienates outside readers. Depressing conclusions.|
What’s at stake? Everything. Your chosen identity/approach will impact your ability to work with providers and the capacity in which you do so, the nature of your P&T case, your ability to get external funding (for which sources, in which amounts), your ability to offer ethical critiques/make normative claims (the kinds of claims), your personal and professional satisfaction, etc. Fortunately, however, all three areas are equally essential for comprehensive inquiry into health and medicine.