Translating biomedical science into clinical practice: Molecular diagnostics and the determination of malignancy

The identification of new biomarkers that help understand the epidemiological basis of patterns of malignancy at a population level is reshaping conceptions of health, disease and normality. These developments create new challenges for clinicians and the ways in which they work with scientists and engage with patients. Bioclinical collectives, an assemblage of laboratory and clinical evidence and practice, comprise different expert groups of scientists and clinicians who typically enact their expertise through boundary work to establish some degree of jurisdictional authority over their practice. Serra (2010) has argued for the existence of 'medical technocracies' wherein each speciality involved defines the boundaries between themselves in daily medical practices and use technology as a resource to construct their particular strategies. In this article we explore these two aspects of biomedical expertise - the collective and the boundaried domains of diagnostic practice (especially in regard to clinical utility) - to understand how haematological malignancy and disease are perceived and managed. The empirical data for the article are based on extensive primary research in hospitals based in the north of the UK, and among clinicians and laboratory scientists working in haematological malignancies. Our chosen field of inquiry - a haematological malignancy diagnostic service in the UK - is a particularly rich site through which to explore these twin aspects.