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Extending the rails: how research reshapes clinics.

JuLeigh Petty¹, Carol A Heimer

¹Center for Medicine, Health, and Society, Vanderbilt University, Nashville,TN, USA.

Social Studies of Science

|September 2, 2011

Summary

Clinical research influences medical practice not only through results but also through its implementation. This study examines how clinical trials reshape healthcare organizations and practices globally, particularly in HIV clinics.

Area of Science:

Sociology of Science
Medical Anthropology
Health Services Research

Background:

Traditional view: clinical research impacts practice solely post-completion.
Challenging this: social studies of science show practice evolves during research.
Focus on HIV clinics across diverse global settings.

Purpose of the Study:

To investigate how the practice of clinical research transforms medical practice.
To analyze the mechanisms through which clinical trials reshape healthcare organizations.
To compare these transformations in high-income versus low- and middle-income countries.

Main Methods:

Qualitative fieldwork in HIV clinics.
Comparative case study approach across US, South Africa, Thailand, and Uganda.

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Analysis of organizational changes related to clinical trials.

Main Results:

Clinical trials alter medical practice by modifying material environments.
Bureaucratic relations within clinics are reorganized due to research activities.
Research values become prioritized, influencing daily operations.
Differences observed in how these processes manifest in wealthier versus poorer countries.

Conclusions:

Clinical research is not separate from practice but actively shapes it.
Organizational transformations are key mechanisms linking trials to practice change.
Contextual factors, especially economic disparities, influence the impact of clinical trials on medical practice.