A careful biomedicine? Generalization and abstraction in RCTs

This article takes up biomedical and public health concerns about the difficulty of generalizing or extrapolating measurements of efficacy produced by the method of the randomized control trial (RCT) to wider populations. While explanations for the difficulty may be deduced from social studies of science that reveal the contingent and situated nature of trial findings, new conceptual tools are required to allow for the practical value associated with the possibility of their extrapolation. We argue that Alfred North Whitehead’s concept of ‘abstraction’ can provide an alternative appreciation of some key aspects of the processes of knowledge-production of RCTs to enable a recasting of the problem of generalization. By proposing that generalization depends on relevant abstractions, we direct attention to the situated forms of care that this calls for. After showing the conceptual difference that the process of abstraction makes for understanding and extrapolating the situated nature of a research finding, we offer an interpretation of possible forms of care at work in efforts to devise Ebola adaptive trials. The example is offered as one possible basis for a reformulation of the logic of generalization.