Premium
Genomic expertise in action: molecular tumour boards and decision‐making in precision oncology
Author(s) -
Bourret Pascale,
Cambrosio Alberto
Publication year - 2019
Publication title -
sociology of health and illness
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.146
H-Index - 97
eISSN - 1467-9566
pISSN - 0141-9889
DOI - 10.1111/1467-9566.12970
Subject(s) - action (physics) , set (abstract data type) , precision oncology , interfacing , precision medicine , psychology , medicine , computer science , pathology , physics , quantum mechanics , computer hardware , programming language
The recent development of cancer precision medicine is associated with the emergence of ‘molecular tumour boards’ ( MTB s). Attended by a heterogenous set of practitioners, MTB s link genomic platforms to clinical practices by establishing ‘actionable’ connections between drugs and molecular alterations. Their activities rely on a number of evidential resources – for example databases, clinical trial results, basic knowledge about mutations and pathways – that need to be associated with the clinical trajectory of individual patients. Experts from various domains are required to master and align diverse kinds of information. However, rather than examining MTB s as an institution interfacing different kinds of expertise embedded in individual experts, we argue that expertise is the emergent outcome of MTB s, which can be conceptualised as networks or ‘agencements’ of humans and devices. Based on the ethnographic analysis of the activities of four clinical trial MTB s (three in France and an international one) and of two French routine‐care MTB s, the paper analyses how MTB s produce therapeutic decisions, centring on the new kind of expertise they engender. The development and activities of MTB s signal a profound transformation of the evidentiary basis and processes upon which biomedical expertise and decision‐making in oncology are predicated and, in particular, the emergence of a clinic of variants .