ABSTRACT
Early this century, I was intrigued by pharmaceutical drugs normally prescribed only for those diagnosed as having cancer being prescribed for women who did not have cancer, but who were newly classified as being at “high risk” for developing breast cancer in order to reduce that risk. This marked a radical shift in how pharmaceuticals are thought about and used, and how “prevention” is understood and enacted. I explored these changes in knowledge production and medical practices as they were emerging in order to make sense of this new phenomenon called chemoprevention.
To tackle the project, I focused on one large-scale chemoprevention clinical trial; such trials are often depicted as the gold standard for biomedical knowledge production. I collected data from multiple sites and positions in order to grasp how the trial looked from different perspectives. Instead of a few devoted people working full-time on conducting this research, the trial I studied actually consisted of numerous people with varying levels of commitment. They included as important players actors located in key organizations and in other often surprising sites and sometimes marginal people, sites, and sources. As I uncovered the layers of experience, action, and meaning that constituted “the trial,” it became increasingly evident that, while ultimately producing what appeared to be a coherent set of knowledges defined as objective, the knowledges being produced were fragmented, partial, and very much situated. To make sense of what all this meant, I had to find new methods. I began with a social worlds analysis, and that evolved into situated analyses as I delved further into the process. This chapter describes my adventures discovering, understanding, and using these methods, including the pitfalls I confronted as well as the pleasures and surprises along the way to completing my dissertation.
