Mapping misconduct: demarcating legitimate science from "fraud" in the B-06 lumpectomy controversy.

• Author: Keranen, Lisa
• Position: National Surgical Adjuvant Breast and Bowel Project

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. I conclude by considering how this case complicates our understanding of public and technical interdependence in a science-based controversy that profoundly influenced patients' sense of security and the high-flying world of federally funded scientific research. In short, this controversy expands the argument spheres literature by showing how broader "epistemic, institutional, and cultural antagonisms" between science and the public (Goodnight, 2005, p. 28) are reworked in consequential ways.

"SPHERES OF ARGUMENT" IN SCIENCE-BASED CONTROVERSY

Because science-based controversies inherently involve both technical and public concerns (Boyd, 2002; Brante, 1993), they provide manifold opportunities for examining the dynamics of technical and public argumentation. The B-06 controversy represents a particularly rich opportunity to revisit our understanding of argument spheres because it invites reflection about the intersection of science, politics, and high stakes medical research from multiple, overlapping sectors of society. All told, the controversy spanned at least seven years, two countries, four federal agencies, 13 academic journals, and 89 collaborative research sites. It involved more than 19 coauthors, 2,163 research participants, more than 200,000 North American women annually diagnosed with breast cancer, and physician-investigators around the globe (Office of Research Integrity, 1993). Although the B-06 trial's overall findings were reaffirmed in a 1994 NEJM reanalysis, lingering distrust of the lumpectomy finding compelled patients to speak out against scientific cover-up. Scientists whose life's work now was clouded by suspicion of scandal clamored for reputational recovery. Called to account for their own (in)actions, politicians and administrators lobbed salvos against scientists and defended their oversight of the matter. Because it concerned allegations of research misconduct in a study with broader public health impact, the controversy enabled challenges to science's epistemic authority from both outside and within the scientific community. Although the furor seemed to emanate in the public sphere and then to push deliberation in the technical sphere, closer inspection reveals that the boundaries between these spheres were reconfigured in different ways as the controversy progressed.

The notion that "different spheres of argument carry different expectations of what constitutes appropriate grounds and authorities for claims" (Boyd, 2002, p. 92) often is traced to G. Thomas Goodnight's (1982) canonical essay on the personal, public, and technical spheres. In the personal sphere, arguments "require only the most informal demands for evidence, proof sequences, claim establishment, and language use" (Goodnight, 1982, p. 220) and "are typically brief and rely on improvised or remembered evidence with little need for documentation" (Boyd, 2002, p. 93). In the technical sphere, arguments emanate from professional communities of arguers and require "more limited rules of evidence, presentation, and judgment" while, in the public sphere, arguments reach "beyond private needs and the needs of special communities to the interests of the entire community" (Goodnight, 1982, p. 220). The B-06 controversy generated all three kinds of arguments, ranging from private justifications for treatment options in the face of grave uncertainty to rather bounded scientific disputes about the statistical meanings of tainted data, to broad community arguments about publics betrayed by science.

To some, the notion of "spheres" implies stable, separate domains of argument with autonomous criteria for epistemic validity. From the outset, however, the interface between the public and the technical has been of interest--particularly in studies of science and technology controversy (see, e.g., Farrell & Goodnight, 1981). "The realm of public argument," Goodnight notes, "can give rise to the ascendancy of technological fields, but public interest may also circumscribe the practice of technical argument" (1982, p. 222). Ceccarelli (2005) observes that "the conflict" between the technical and public spheres "is a perennial one" (p. 32) and technical encroachments into the public sphere are well known (e.g., Farrell & Goodnight, 1981). While Goodnight (1982) acknowledges that arguments sometimes traverse spheres, others have criticized an implied "unidirectional process of influence, from the technical to the public" (Taylor, 1996, p. 128) and argued that the two spheres can intertwine (Phillips, 1996). Indeed, that science-based controversies typically feature a fusion of argument spheres has led several authors to examine their interdependence. Fabj and Sobnosky (1995), for example, have shown how AIDS activists use translation and redefinition across argument spheres to expand the space for public arguments in technical debates over AIDS research.

More recently, drawing from previous studies (e.g., Olson & Goodnight, 1994), Boyd has argued that controversies in which "a regulatory agency and its prescribed technical standards are added to a science-based controversy" also "bridge the public and technical spheres of argumentation" (Boyd, 2002, p. 92). The B-06 lumpectomy controversy is one such regulatory controversy, involving, among other agencies, the Office of Research Integrity (ORI), which oversees federally sponsored health research, the National Cancer Institute (NCI), which funded the NSABP research, NEJM, which published the original research, and the University of Pittsburgh, which administered NSABP grant monies. Boyd (2002) explains that in regulatory controversy "technical discourses become part of public appeals and public concerns drive technical investigations" (p. 107). As we shall see in the case of B-06, this process involves multiple, overlapping, sometimes consonant but oftentimes conflicting activations of the spheres.

Boyd's...