Interview with Steve Sturdy


A few hours after his plane landed in Valencia, Steve Sturdy met us in the López Piñero Institute for the History of Medicine and Science to hold an interview with us. He is currently in charge of the department of Science, Technology and Innovation Studies at the University of Edinburgh, in which he has been working for almost 20 years.

His visit to Spain can be summarized in one sentence «Looking for Trouble: Medical Science and Clinical Practice in the Historiography of Modern Medicine», which is also the title of his seminar. In this seminar he tried to show the different stages the relationship between medical science and medical practice has gone through.

Despite the relevance of his studies, Sturdy speaks plainly and naturally. He talked about his studies on late 19th and early 20th century science, politics and medicine. He thinks that the relationship between researchers and physicians has to be symbiotic. Sturdy also gave his opinion on the privatisation of the healthcare system, as well as on the situation Spanish researchers are facing after the government cutbacks on research. His years studying Natural Sciences and Philosophy of Science at Cambridge University, Western Ontario University and the University of Edinburgh back him up.

You are currently leading a genomics forum, integrated in a genomics network, including several centres devoted to social, philosophical and historical studies. Can you explain what does it consist on for the Spanish academic community? 

  The Genomics Network was set up in 2002. It’s a network of three social science research centres funded by the Social Science Research Council. It came out of a big initiative by the British government to fund research in science, medicine and agriculture in the wake of the publication of the first draft of the human genome. The social science Genomics Network was founded to look at the likely implications of biological research and innovation in this area. The government and the research councils were concerned there would be public concern about this new scientific developments.

This is interesting because it seems that, in our case, this concern is transferred more to philosophers, moralists, ethicists… Are your groups basically made up of social scientists? I mean sociologists, historians…
Yes. And there are biomedical ethicists, particularly around medical issues. But they don’t deal so much with areas of considerable economic importance— agriculture or biotechnology, for instance. They only cover part of the field.

And do you integrate them with experimental scientists working in agriculture, in experimental biology or genomics itself, or are they separated?
Well, that’s where the Genomics Forum comes in. There are three social science research centres, who do the research. But then, the genomics forum was set up to take that research to other audiences. So it is a knowledge exchange organisation. We don’t do research, we do engagement and knowledge exchange with these other audiences, including scientists, medics…

This is very republican and very political, in the traditional sense of the word politics.
It is. It is also very experimental because scientists are very used to talking to social scientists, even policy makers are used to talk to social scientists in this area. So we’ve had to do a lot of work to build up credibility, to persuade people the work we do is interesting and important.

You have perceived reactions and conflicts in some points. Can you be more specific?
There are some issues. For instance, the retention of tissue and DNA samples, where the government is very concerned about the implication of privacy and human right’s legislation. And there we’ve had great difficulty getting to policy makers because they hide behind lawyers. I think defensive is the right word. They are looking to make sure that they are working within the law and they have legal defenses. The government is not so interested in public attitudes… they are simply interested in making sure they have the legal defenses in place.

What about the property of biological products? Have you discussed these specific topics, like patents?
We have. We have done a number of public engagement activities around those. Early on, biotechnology companies were very keen to patent and to protect their intellectual property. But it became clear, and working science and technological studies helped to make these clear, that excessive patenting slowed down research and new product innovation. So actually companies lost out and defeated their own object by patenting too much.

By privatising the results of research?

Yes. There are now moves to an open science model, sharing of information, or permissive intellectual property protection regimes that allow people to use protected information much more liberally than they would have done. Also one of the implications in this, of course, is the way you are dealing with human DNA. You are dealing with personal information and you need people to participate in the research. You need the public to sign up. And it is very clear that, in Britain at least, the public is very happy to sign up to donate parts of their bodies for research. But what they don’t want is to see that information privatised. So companies have realised that if they want to do research with people, they have to be liberal in the way they protect their intellectual property.

On a different note, you are giving a lecture named «Looking for trouble: medical science and clinical practice in the historiography of medicine». Can you explain what does it consist on?
Most of my research to date has been about the relationship between science and scientific research and medical practice. There is a very wide spread rhetoric among doctors, among scientists, that the relationship between research and medical practice is one of tension. So there is a wide spread perception, for instance, that it is difficult to get the results of scientific research in the clinic usually because scientists claim that clinicians are conservative, are not receptive to new ideas that stuck in their ways. But that is, if you look at the history of medicine, plainly rhetoric … there are times when doctors have been conservative, there were also times when scientists were excessively aggressive in their attempts to impose new ideas on medics which don’t necessarily work. There is a lot of scientific innovations that, when you take into clinics, actually don’t work in clinical settings.

So you are talking not only about the past but also about the present…

SYes, I think this runs through into the present. And I think this rhetoric is both untrue and counterproductive. It tends to create antagonisms where there aren’t antagonisms. In fact, therw is a long history of clinicians and scientists working together, of the innovations coming from the clinics into scientific laboratories as well as the other way around.

Do you think that this division, this dichotomy between scientists and clinicians, due to these new forms of medicine, like genomic medicine, will be broken? In the sense of getting together the role of clinicians also being scientists, and scientists working in the clinics…

I think so. I think there are a lot of areas in genomic medicine, for instance, where clinic innovations are taking place. But clinical trials methodologies simply don’t work, they are not appropriate. And a lot of the information that is coming out, like cytogenetics, are looking at changes in chromosomes, which have healthy effects. Often, it only relates to people within a single family, and you can’t do a clinical trial on such a small number of people. So, to produce knowledge of the nature of the illness and the effects of treatment, you have to work much more with the knowledge the clinician has of those individuals. So, in those settings, a lot of the innovation is happening in the clinic with clinicians working with scientists, but clinicians leading the way, identifying the problems, working with geneticists to look for the underlying genetic causes… But the interpretation, the meaning of the science, has to be understood in the clinical setting. Historically there are a lot of places where that has been the case as well. Work in immunology and immunotherapies, for instance, came out of clinical work, and then was taken to laboratory research. So this is not a new thing, but I do think amount of work going on in genomics at the moment really makes this a point of change in development where clinicians and scientists have to work together.

What is the future of citizenship rights, in front of this individualistic orientation of genomic medicine, in order to decide «I want this» or «I don’t want this»?

I think it is changing the economics in medicine, and iti s changing the regulatory structures in medicine. So I think, increasingly , and this is what our particular research brand study, I think we are seeing a change from a mass market medicine that was concerned with the diseases’ populations, particularly with common diseases, and that were structured around knowledge of the population average. Clinical trials look at the population average.
Financial reinvestment structures, the business models, were structured around blockbuster drugs, drugs that could be sold to a lot of population. And increasingly I think in genomic medicine we are moving to a situation where, effectively, drug companies are looking to sell very expensive drugs to very small populations. The regulatory structures are changing. To facilitate that, the number of drugs that get to the market without going through clinical trials is increasing, particularly in genomic medicine. And patients are very important for that, both as people who say «yes, this drug works for me», and as people who are able to pressurise governments to fund those drugs.

It sounds like it is the end of the Welfare State and Welfare State Medicine with universal treatment for everybody.
SYes, this is going to be the major problem that will have to be addressed: about the way that medicines are financed, about how governments or insurance funds decide where to allocate funds for different kinds of medicines, and about whether we actually have a Welfare State that provides basic health care for the population as a whole… or if it’s become channelled into expensive medicines for a minority people.

And do you think we could be able to be successful in this attempt to get government funding for personal medicines?
Historians can’t predict the future (laughs). But in my optimistic moods, I hope this will lead to a thorough rethink of what the medical system is for. Whether it is for providing minimum benefits from expensive medicines for small populations or whether it is much more about a system of care and support for people with all kinds of infirmities. And I hope those debates will be had. If I am pessimistic, I worry that this will be the end of universal health care, and that will shift to a system of increasingly privatised medicine for the wealthy.

Are we following in the footsteps of the American model?
Yes, increasingly. I think the big question will be whether the pharmaceutical companies in particular, who are really big players in this, decide that they are simply not making enough money out of privatised personalised health care, that that business model simply collapses, or else they become a small sector within the bigger system of health care that still cares for all the kinds of infirmities that people suffer from. So I think it is a very interesting time. I think the economics are changing and the pharmaceutical companies recognised that they are in something of a crisis, so they may well want to change the way they think.

Changes that are happening in Europe, and particularly here in Spain, in relation to cutbacks in funds and grants for research, are causing that most Spanish young researches are going abroad. And there is a certain geographical mobility, not only here, but all over the world… is this something that you think is worrying or is it normal that scientists go, and come back, and move from one place to another?
Interesting. There was a concern in Britain in the 1960’s, we called it the «brain drain». It happened but then it stopped, and Britain invested in other areas of science when it had the funding. If you look at India or Indonesia, a lot of their scientists left, went to the United States, came to Europe to train, and now increasingly they are going back. I think scientists move back and forth… the question here is «is it really worth it?»

We don’t know to what extent do we have to think on a Spanish research system or in a French research system… maybe we have to start thinking in an European research system or an international one, much more interrelated. I think the national model, in many senses, but also in research, is one of the points of the crisis in this moment. The «national» idea.
The UK national research funding is still going good, but more and more we look to the European Research Council; for funds we collaborate with people elsewhere in Europe. But there is another thing to bear in mind— the government funding research is a very small part of the research effort, most research now is funded by multinational corporations.

Multinational, but… public or private?
MPrivate multinational corporations. There are far more scientists in private employment than there are in the state, and they move around depending on where the research is cheapest to do. Lots of people are going to India or Indonesia

This is easy to understand in technology, engineering, medicine… Maybe there are some more basic areas of public research for which national funds are still important..
Those national funds are usually tied up with the expectation that there will be some return on the investment, that it will contribute to economic growth. It is happening in Scotland at the moment. I will talk in the language of «knowledge economy».

«Knowledge economy»… So you have to justify what you receive. You have to give reasons and arguments in order to show that it is going to contribute not only to the production of knowledge but also to this knowledge economy.

Yes. So the big idea in Scotland, at the moment, is that we have a very good biomedical research system, we have a good system of university hospitals all well connected… and we have a sick population. We have one of the unhealthiest population in Europe. And we can get the pharmaceutical companies to come to Scotland to do clinical trials… so they bring money to do research. So small investment in a national research effort brings in international research. That’s the model, that is the ideal.

Don’t you think that the British system has been more international in the past? You are used to go to Australia, South Africa, United States, Canada … But here, if our scientists go to Germany, France or to Britain, we have the perception that we are losing something when in fact this is a very permeable system where people go and come back depending on social, economic and scientific conditions.
Science grows through circulation. Scientific ideas are developed through contact between people, through sharing. The bigger your community to share, with the better. And of course Spain has good connections with one of the fastest growing areas in the world, which is Central and South America. There’s a lot of development going on there. We, now, in Edinburgh, are getting increasing numbers of students coming to do science studies from Mexico, Brazil, Colombia, Chile… because they see this is a very important area of growth, so they want to come, learn and take it back to their countries. And if you could participate in that growth…

Josep Lluís Barona. Full Professor of History of Science at the University of Valencia.
Andrea González. Student of Journalism at the University of Valencia.
© Mètode 2012.


«It became clear, and working science and technological studies helped to make these clear, that excessive patenting slowed down research and new product innovation»

















«Companies have realised that if they want to do research with people, they have to be liberal in the way they protect their intellectual property»












«There’s a lot of scientific innovations that, when you take into clinics, actually don’t work in clinical settings»





















«There’s a lot of scientific innovations that, when you take into clinics, actually don’t work in clinical settings»



















«The economics are changing, the pharmaceutical companies recognised that they are in something of a crisis, so they may well want to change the way they think»

















«Science grows through circulation. Scientific ideas are developed through contact between people, through sharing»


© Mètode 2012