Who controls indeterminacy in the doctor–patient encounter defines the nature of professional power. Evidence-based medicine (EBM) is one such control strategy claiming to reduce uncertainty by identifying effective (and efficient) interventions and by removing ineffective treatments from clinical practice. EBM, however, as a means of keeping some autonomy for a profession beset by increasing government control, has had to compete with other professionalizing strategies within medicine. And, despite its promise, EBM is shown not to have reduced indeterminacy but to have shifted the problem into a wider policy arena that involves interpreting evidence. Moreover, in an era of concern for patient safety, EBM is proposed as part of a solution (through its claim to reduce uncertainty about the effect of interventions) but remains itself a potent source of danger and increased indeterminacy.

Many researchers working in the field of human genetics in the United States have been caught between two seemingly competing messages with regard to racial categories and genetic difference. As the human genome was mapped in 2000, Francis Collins, the head of the publicly funded project, together with his privately funded rival, announced that humans were 99.9 percent the same at the level of their genome. That same year, the National Institutes of Health (NIH) began a research program on pharmacogenetics that would exploit the .01 percent of human genetic difference, increasingly understood in racial terms, to advance the field of pharmacy. First, this article addresses Collins’ summary of what he called the ‘vigorous debate’ on the relationship between race and genetics in the open-access special issue of Nature Genetics entitled ‘Genetics for the Human Race’ in 2004. Second, it examines the most vexed (if not always openly stated) issue at stake in the debate: that many geneticists today work with the assumption that human biology differs by race as it is conceived through American census categories. It then presents interviews with researchers in two collaborating US laboratories who collect and organize DNA by American notions of ‘race/ethnicity’ and assume that US race categories of classification largely traduce human biogenetic difference. It concludes that race is a practical and conceptual tool whose utility and function is often taken for granted rather than rigorously assessed and that ‘rational medicine’ cannot precede a rational approach to addressing the nature of racial disparities, difference and inequality in health and society more broadly.

This article considers the complex construction of randomized controlled trials that lies behind the rhetoric of the gold standard. Drawing on insights from Science and Technology Studies and empirical material, I argue that trials in the field of cardiovascular disease prevention are constituted as ‘research’ rather than ‘science’. In these examples, control emerges out of a dual concern with practices of purification and involvement of aspects of the world outside the experiment, as the designers of trials aspire to relevance as well as rigour. Such strategies of ‘contextualization’ mean that trials are more like alchemy than assay, proceeding by complex moves to transform ‘base’ matters rather than distilling elements of clinical practice.

Following the stringent critiques of organizers of the Human Genome Diversity Project for excluding people from the initiative’s early planning, subsequent administrators of high-profile efforts to study human genetic variation, such as the International HapMap Project, have made great efforts to stress the importance of including the people who are to be the objects of study in research design and regulation. Such efforts to ‘democratize’ genomics would appear to represent a positive development. However, in practice they have satisfied few as they fail to recognize the most basic lesson of the Human Genome Diversity Project debates: genomics raises questions not just about the inclusion of people, but about their very constitution. Positing concrete, stable subjects in society, current efforts to ‘democratize’ genomics fail to recognize that entangled in the fundamental questions about nature posed by this emergent form of technoscience are fundamental questions about the order and constitution of societies. The creation of sustainable and desirable forms of governance require us to come to terms with challenges posed to liberal democratic practices and values, such as inclusion, in an age defined partially by this mutual dis/ordering of nature and society.

Evidence-based medicine emerged in connection with struggles for clinical authority in the second half of the twentieth century, as patient-centred medicine and community-oriented medicine presented challenges to laboratory-oriented medicine. The renowned medical researchers Alvan Feinstein and Archie Cochrane helped to develop the new models of patient-centred and community-oriented medicine respectively. They made important contributions to methodological reflections in medicine, and also contributed to social theories about clinical medicine and health care, challenging and criticizing in different ways dominant ontological medical understandings (such as essentialist conceptions of disease and illness). The medical ontologies of patient-centred and community-oriented medicine comprise different (partly incompatible) perspectives on what constitutes standards of evidence, something reflected, for example, in Feinstein and Cochrane’s contrary views on the importance of controlled trials. The analysis of their work in this article illuminates the connection between medical ontologies, standards of evidence and the political in general, reminding us of the need to explore the role of politics in discussions of evidence-based medicine.

‘Racial’ or ‘ethnic’ drugs, a product of the new genetics and its mapping of genomes and populations, are now being developed and manufactured on a large scale. This article focuses on the conceptualization and identification of genetic signatures at the population level, many of which, I argue, evoke the ancient and quite common folk idiom of bodily inscription—in particular, fingerprints and birthmarks. The current geneticization of ‘colour’ and the biosociality engendered by it, I suggest, invite critical rethinking of the concept of insular populations and the distinction between bodily surface and deep structures (phenotype and genotype). While the new genetics has shifted the conceptual ground for discussions of human variation, moving away from phenotypic traits such as markings of the skin, drawing attention to what some molecular biologists refer to as the ‘universe within’, the notion of racial difference is repeatedly reinvented along familiar lines, under the banner of populations studies. I argue that, although human variation is both a legitimate and important subject in its own right and some approaches to variation do a better job than others, researchers need to be attentive to their assumptions about sampling. Circularity and subjectivity seem to be inevitable parts of the exploration of human diversity, and sampling cannot take place without a subjective, pragmatic judgment about how to proceed.