The Politics of Therapeutic Evaluation: The Vitamin C and Cancer Controversy

Abstract

This paper reconstructs and analyzes the content and context of the debate over the efficacy of vitamin C in the treatment of cancer, and compares it with medical responses to, and evaluations of, two other cancer drugs — the cytotoxic drug SFU (conventionally used in the treatment of gastro-intestinal cancers) and the `naturally-occurring' (but recombinant DNA-produced) drug interferon. This comparative approach is designed to facilitate the integration of microsociological and structural levels of analysis of the processes by which knowledge claims about therapeutic efficacy are evaluated by the powerful adjudicating medical community. It is argued that the assessment of medical therapies is inherently a social and political process; that the idea of neutral appraisal is a myth; that clinical trials, no matter how rigorous their methodology, inevitably embody the professional values or commitments of the assessors; and that judgements about experimental findings may be structured by wider social interests, such as consumer choice or market forces. It is concluded that the necessarily social character of medical knowledge cannot be eliminated by methodological reform, and that this has important implications for the social implementation of medical therapies and techniques.

Three Conceptual Models of Patient and Public Involvement in Standard-setting: From Abstract Principles to Complex Practice

“…Instead of a normative void in which power and confusion thrive, practice is overflowing with competing and overlapping norms, a 'normative surfeit' (Zuiderent-Jerak, 2007). Moreover, not only does the introduction of scientific models and facts rarely resolve existing controversies (Richards, 1988;Zeiss and Van Egmond, 2014), we can expect even less agreement here as PPI models themselves are multiple and partially contradictory. Recognizing the plurality and potentially conflicting nature of lay involvement models, Van Oudheusden and Laurent suggest not to replace actors' norms with our own, but 'first and foremost stress the need to explore with actors the types of engagement that demand articulation in a given situation without prescribing which [public engagement] mode is more appropriate ' (2013, p. 18).…”

Orthomolecular Oncology Review: Ascorbic Acid and Cancer 25 Years Later

“…This issue has been reviewed elsewhere. 154 A critical point of both studies (Mayo Clinic and Pauling's) is that they used oral doses of ascorbate of about 10 g. Given the saturable gastrointestinal absorption and the nonlinear renal clearance, 155 oral absorption of AA cannot achieve plasma concentrations comparable to those obtained by intravenous administration. 44 Plasma concentrations of AA rise as the dose ingested increases until a plateau is reached with doses of about 150 to 200 mg daily.…”

Formats of responsibility: elective surgery in the era of evidence‐based medicine

“…Medical and surgical work is shown to entail the coordination of heterogeneous human and nonhuman actors (Mol 2002a, 2002b, Moreira 2001, Pope 2002. Medical knowledge, in the clinic and in research, is shown to necessarily intertwine what would have once been seen as separate entities -'social' and 'clinical' factors (Berg 1992, Richards 1988, Silverman 1987. Pope (2002) emphasises that surgical practice is contingent, in that action is always conditional on a number of contextual factors (pertaining to the case at hand, the surgeon, and features of the environment surrounding surgical work).…”