Mapping Misconduct: Demarcating Legitimate Science from "Fraud" in the B-06 Lumpectomy Controversy
Keranen, Lisa, Argumentation and Advocacy
On March 13, 1994, a front-page Chicago Tribune headline announced "Fraud in Breast Cancer Study: Doctor Lied on Data for Decade" (Crewdson, 1994, p. A1). This journalistic intervention into the highly politicized world of federally funded breast cancer research triggered an extended science-based controversy that pivoted around allegations of misconduct in the nation's premier breast cancer research. The research in question concerned a portion of the National Surgical Adjuvant Breast and Bowel Project known as the B-06 Protocol. This large-scale, multisite clinical trial had demonstrated that breast-conserving lumpectomy, followed by irradiation, was as effective as breast-removing mastectomy for early-stage breast cancers. This finding, published in the 1980s in the authoritative New England Journal of Medicine (NEJM), was heralded as a revolution in women's health care; it would inform treatment decisions of tens of thousands of North American women and their health care providers (Altman, 1996; Fisher, Bauer et al., 1985; Fisher, Costantino et al., 1993; Fisher, Redmond et al., 1989). Following revelations that one of the study's lead investigators had falsified B-06 data, "all hell broke loose" (Twedt & Carpenter, 1994, p. A6). (1) The ensuing saga of misdeeds and miscommunication in the nation's landmark breast cancer study exposed fissures in the scientific community's sense of legitimate scientific practice and undermined public confidence in clinical research. Careers plummeted. Public fury mounted. Scientists, politicians, and patients were left scrambling to pick up the pieces.
Contemporary controversies such as the B-06 imbroglio highlight how, far from being immutable, standards of "legitimate" scientific practices are negotiated in contested cases that expose--and provide opportunity to resolve--conflicting senses of appropriate practice (see Lynoe, Jacobsson, & Lundgren, 1999). As stakeholders struggled to make sense of the controversy's implications for life-and-death breast cancer treatment decisions, their arguments generated implicit maps of legitimate scientific practice that rhetorically constructed boundaries between science and its stakeholders and between public and technical realms of expertise (Gieryn, 1999). These maps are deeply consequential for participants because they can affect the progression, meanings, and outcomes of science-based controversies.
In this essay, I analyze how--and with what consequence--the borders between the technical and the public were demarcated argumentatively in the B-06 lumpectomy controversy. Drawing from Thomas F. Gieryn's (1999) critical metaphor of "cultural cartographies of science," I trace the production of implicit maps of scientific practice across prominent medical journals, newspaper accounts, and Congressional hearings in the months immediately following public disclosure of problems with B-06 data. More specifically, I argue that the discourse of patients, lawyers, journalists, researchers, and elected officials produced multiple and competing maps of the scientific terrain that, together, rhetorically constituted the borders between the public and the technical in ways that maintained institutional jurisdiction over scientific decision making and missed a crucial opportunity to address stakeholder concerns more meaningfully. This argument is not to imply that participants did not recognize and maintain distinctions between the technical and public spheres of argument. Rather, it is to suggest that at various moments during the controversy, participants actively renegotiated the public and technical in ways that matter for both participants and scholars of argument.
In order to explore the consequences of particular maps of scientific practice in the B-06 lumpectomy controversy, I begin by reviewing the argument spheres literature as it pertains to science-based controversy studies. I then examine the B-06 controversy and the implications of four dominant maps that emerged during its initial months. …