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Out of sight: problem sequences and epistemic boundaries of medical know-how on glaucoma

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Abstract

This paper analyses the process of knowledge growth in a branch of medical science. It proposes a study on the scientific advances in glaucoma research organized in two parts. The first presents a qualitative overview of the problem sequences that have characterized 150years of medical research in ophthalmology. This is complemented in the second part by a network analysis of scientific publications and collaborations of the last 50years. Medical knowledge, we surmise, is punctuated by patterns of specialization, diversification and coordination that emerge both within and among scientific, technical, institutional and organizational realms.

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Notes

  1. http://www.glaucomafoundation.org/.

  2. This was primarily due to data availability limitations.

  3. As Metcalfe and Ramlogan (2005; 658) put it: “We can never say two individuals have the same knowledge, nor devise a way of establishing what they know. We can say instead that as individuals they have the same understanding in so far as they provide indistinguishable or at least closely correlated answers to the same question or if they respond in indistinguishable ways to the same instructions.”

  4. In ophthalmology and on glaucoma in particular we record Weller’s “Trattato teorico e pratico delle malattie degli occhi”—Theoretical and Practical treatise of Eye disease—(1826) and Mc Kenzie’s “Practical treatise on the diseases of the Eye” (1833).

  5. Analyses of knowledge growth often point to cumulativeness as a key property. This is discussed in relation to concepts such as localization and proximity on a metaphorical knowledge space (cf. Castaldi and Dosi 2005). While we do not represent such a space, our network analysis can claim to have advanced these concepts by offering a visual representation of the areas in which medical knowledge has been applied.

  6. In a wider sense, at the system level we are concerned with the emerging coordination—rather than the aggregation—of these paths unfolding together, yet at different velocities. If path-dependence is held as the relevant property, the phenomenon we are concerned about is some form of system-dependence, which reflects how multi-level coordination shapes the configuration of a system conceived here as an ensemble of different histories developing autonomously, yet in a correlated fashion.

  7. The optic nerve plays a fundamental role as it connects the eye to the brain.

  8. A comprehensive, yet accessible also to non-practitioners, overview of the state-of-the-art in research on glaucoma can be found in the authoritative article by Quigley (2004). See also Consoli et al. (2005).

  9. To be fair, Priestley Smith was the only ophthalmologist who ‘sung from a different hymn sheet’ by stating that glaucoma was due to faulty aqueous drainage rather than to excessive production of humor. After noticing other features such as the occurrence of a small globe, a large lens and the shallow anterior chamber, he realized ante litteram that structural features of the eye and vascular causes are somehow associated with glaucoma.

  10. Iridectomy is a surgical procedure consisting in the excision of a small section of the iris.

  11. Louis de Wecker is accredited to have provided a key stimulus to the development of an apposite fistulous track for the drainage in 1882.

  12. That is, by how much the cornea is shifted by the built-in plunger. In this rather invasive procedure it is common to numb the surface of the eye with eyedrops.

  13. Thus, the iridectomy performed by von Graefe was successful for the ‘wrong’ conceptual reasons as the iris is not responsible for the production of the humor, but removing it facilitates the outflow.

  14. Figure 2 shows that the angle is the area between the iris and cornea which contains the trabecular meshwork.

  15. The database was extracted from the Institute for Scientific Information (ISI) data resources using the keyword glaucoma.

  16. Together with cross-fertilization of different bodies of science at the core of this phenomenon are changes in ISI policy for a wider inclusion of scientific journals where glaucoma-related studies are published.

  17. Garfield (1979) also established a strong correlation exists between citation rates and peer judgments in several areas/disciplines.

  18. McMeekin 2005 provides a detailed case study of the development of these diagnostic technologies.

  19. This statistic measures the proportion of links which exist between all members in a network relative to potential links if all nodes connected with each other.

  20. The degree centrality of each node expressed as a proportion of the maximum degree—that is the number of other nodes in the network (de Nooy et al. 2005, p. 128). Various measures for centrality are available in the social network literature (see also the discussion of their limitations in Borgatti 2005). For the purpose of this exercise the normalised degree centrality available in the software program Pajek was used.

  21. In order to make the figure more presentable we limited the labeled nodes to those discussed in the text.

  22. Echoing the warnings of Mokyr (1998) and Loasby (2001), our evolutionary view is not based on a mechanism of Neo-Darwinian blind selection, but rather on guided selection. The variation we deal with is the result of specific choices in search of a solution to a problem. As we will make clear in the remainder, these choices are shaped, and to some extent also constrained, by the path of evolution of scientific understanding.

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Acknowledgements

The financial support of the ESRC Innovative Health Technologies programme is acknowledged. During this project we had the opportunity to interview Dr. Harry Quigley (Wilmore Eye Institute at John Hopkins University) to whom we remain gratefully indebted. Thank you also to Dr. Françoise Baubet-Giunta for her qualified guidance. Parts of this research were presented at the DRUID Tenth Anniversary Summer Conference 2005 on “Dynamics of Industry and Innovation: Organizations, Networks and Systems” at the Copenhagen Business School, (Denmark) in June 2005. On that occasion we received much appreciated comments from Brian Loasby and Anne Plunket. We also thank two anonymous referees of this journal who have encouraged us to improve substantially the paper. Last but not least we are grateful to Stan Metcalfe, Andrew McMeekin, Andrea Mina and Gindo Tampubolon for inspiring teamwork and allowing us to build upon joint work. The usual disclaimers apply.

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  1. Manchester Institute for Innovation Research, Manchester Business School, University of Manchester, Harold Hankins Building, Booth Street West, M13 9QH, Manchester, UK

    Davide Consoli & Ronnie Ramlogan

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  1. Davide Consoli
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Correspondence to Davide Consoli.

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Consoli, D., Ramlogan, R. Out of sight: problem sequences and epistemic boundaries of medical know-how on glaucoma. J Evol Econ 18, 31–56 (2008). https://doi.org/10.1007/s00191-007-0074-4

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