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Ginod P, Dahan MH. Preimplantation Genetic Testing for Polygenetic Conditions: A Legal, Ethical, and Scientific Challenge. Semin Reprod Med 2024; 42:60-68. [PMID: 38519038 DOI: 10.1055/s-0044-1782618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
The recent commercialization of the Embryo Health Score (EHS), determined through preimplantation genetic testing for polygenic conditions, offers the potential to select embryos with lower disease risk, thus potentially enhancing offspring longevity and health. Lately, Orchid Health company increased testing from less than 20 diseases to more than 900+ conditions for birth defects. However, the "geneticization" of phenotype estimates to a health state erases the environmental part, including the in vitro fertilization potential risks, questioning its scientific usefulness. EHS is utilized in countries with minimal regulatory oversight and will likely expand, while it remains illegal in other countries due to ethical and legal dilemmas it raises about reproductive autonomy, discrimination, impacts on family dynamics, and genetic diversity. The shift toward commercialized polygenic embryo screening (PES) redefines healthcare relationships, turning prospective parents into consumers and altering the physician's role. Moreover, PES could increase social inequalities, stigmatize those not born following PES, and encourage "desirable" phenotypic or behavioral traits selection, leading to ethical drift. Addressing these issues is essential before further implementation and requires a collaborative approach involving political, governmental, and public health, alongside geneticists, ethicists, and fertility specialists, focusing on the societal implications and acceptability of testing for polygenic traits for embryo selection.
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Affiliation(s)
- Perrine Ginod
- MUHC Reproductive Centre, McGill University, Montréal, Quebec, Canada
- CHU Dijon Bourgogne, Service de Gynécologie-Obstétrique et Assistance Médicale à la Procréation, Dijon, France
| | - Michael H Dahan
- MUHC Reproductive Centre, McGill University, Montréal, Quebec, Canada
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, McGill University, Montréal, Quebec, Canada
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2
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Higuita-Gutiérrez LF, Estrada-Mesa DA, Cardona-Arias JA. Social representations of cancer in patients from Medellín, Colombia: a qualitative study. FRONTIERS IN SOCIOLOGY 2023; 8:1257776. [PMID: 38108048 PMCID: PMC10722234 DOI: 10.3389/fsoc.2023.1257776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/10/2023] [Indexed: 12/19/2023]
Abstract
Background Cancer has different explanatory theories that address its etiology and treatment. It is usually associated with pain and suffering. Recently, new technologies, knowledge, and therapies have been developed, which may have transformed the classic social representations of the disease. This study aimed to understand the social representations (SRs) of cancer in patients from Medellín, Colombia. Methods This study used a grounded theory in 16 patients with cancer. The information was collected between June 2020 and May 2021. Information was analyzed following the open, axial, and selective coding stages. Results SRs of cancer at the time of diagnosis evoke negative connotations. However, cancer is redefined as a positive event as the clinical course of the disease progresses, and patients interact with health professionals and respond to treatment. The resignification of the disease depends on the etiological models of the patients, which include genetic, socio-anthropological, psychosocial, and psychogenic factors. In line with the SRs of etiology, patients seek out treatments complementary to the biomedical ones that can be socio-anthropological and psychogenic. Conclusion In this group negative representations about cancer persist, this way of understanding the disease is determined by the convergence of cultural meanings and personal experiences. The causal representation is connected to the actions and willingness of the patients to face their diagnosis. In this sense, two categories stand out: the first expresses that cancer is the consequence of a body subjected to excessive productivity; the second subsumes a psychogenic predisposition caused by the context where the ideology of happiness appears to be a social norm. This double saturation in which an individual is immersed results in new burdens that are not visible to caregivers and healthcare workers.
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Affiliation(s)
- Luis Felipe Higuita-Gutiérrez
- School of Medicine, Universidad Cooperativa de Colombia, Medellín, Colombia
- School of Microbiology, Universidad de Antioquia, Medellín, Colombia
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3
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Mukherjee M, Eby M, Wang S, Lara-Millán A, Earle AM. Medicalizing risk: How experts and consumers manage uncertainty in genetic health testing. PLoS One 2022; 17:e0270430. [PMID: 35925961 PMCID: PMC9352100 DOI: 10.1371/journal.pone.0270430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/10/2022] [Indexed: 11/28/2022] Open
Abstract
Given increased prevalence of direct-to-consumer (DTC) genetic health tests in recent years, this paper delves into discourses among researchers at professional genomics conferences and lay DTC genetic test users on popular discussion website Reddit to understand the contested value of genetic knowledge and its direct implications for health management. Harnessing ethnographic observations at five conferences and a text -analysis of 52 Reddit threads, we find both experts and lay patient-consumers navigate their own versions of “productive uncertainty.” Experts develop genetic technologies to legitimize unsettled genomics as medical knowledge and mobilize resources and products, while lay patient-consumers turn to Internet forums to gain clarity on knowledge gaps that help better manage their genetic risk states. By showing how the uncertain nature of genomics serves as a productive force placing both parties within a mutually cooperative cycle, we argue that experts and patient-consumers co-produce a form of relational medicalization that concretizes “risk” itself as a disease state.
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Affiliation(s)
- Meghna Mukherjee
- Department of Sociology, University of California Berkeley, Berkeley, California, United States of America
- * E-mail:
| | - Margaret Eby
- Department of Sociology, University of California Berkeley, Berkeley, California, United States of America
| | - Skyler Wang
- Department of Sociology, University of California Berkeley, Berkeley, California, United States of America
| | - Armando Lara-Millán
- Department of Sociology, University of California Berkeley, Berkeley, California, United States of America
| | - Althea Maya Earle
- Department of Sociology, University of California Berkeley, Berkeley, California, United States of America
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4
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Green S, Carusi A, Hoeyer K. Plastic diagnostics: The remaking of disease and evidence in personalized medicine. Soc Sci Med 2022; 304:112318. [PMID: 31130237 PMCID: PMC9218799 DOI: 10.1016/j.socscimed.2019.05.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 05/14/2019] [Accepted: 05/16/2019] [Indexed: 12/15/2022]
Abstract
Politically authorized reports on personalized and precision medicine stress an urgent need for finer-grained disease categories and faster taxonomic revision, through integration of genomic and phenotypic data. Developing a data-driven taxonomy is, however, not as simple as it sounds. It is often assumed that an integrated data infrastructure is relatively easy to implement in countries that already have highly centralized and digitalized health care systems. Our analysis of initiatives associated with the Danish National Genome Center, recently launched to bring Denmark to the forefront of personalized medicine, tells a different story. Through a "meta-taxonomy" of taxonomic revisions, we discuss what a genomics-based disease taxonomy entails, epistemically as well as organizationally. Whereas policy reports promote a vision of seamless data integration and standardization, we highlight how the envisioned strategy imposes significant changes on the organization of health care systems. Our analysis shows how persistent tensions in medicine between variation and standardization, and between change and continuity, remain obstacles for the production as well as the evaluation of genomics-based taxonomies of difference. We identify inherent conflicts between the ideal of dynamic revision and existing regulatory functions of disease categories in, for example, the organization and management of health care systems. Moreover, we raise concerns about shifts in the regulatory regime of evidence standards, where clinical care increasingly becomes a vehicle for biomedical research.
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Affiliation(s)
- Sara Green
- Section for History and Philosophy of Science, Department of Science Education, University of Copenhagen, Øster Voldgade 3, 1350, Copenhagen, Denmark; Centre for Medical Science and Technology Studies, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, PO Box 2099, 1014, Copenhagen K, Denmark.
| | - Annamaria Carusi
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Medical School, Beech Hill Road Sheffield, S10 2RX, United Kingdom.
| | - Klaus Hoeyer
- Centre for Medical Science and Technology Studies, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, PO Box 2099, 1014, Copenhagen K, Denmark.
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5
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Raz A, Timmermans S, Eyal G, Brothers K, Minari J. Challenges for precision public health communication in the era of genomic medicine. Genet Med 2022; 24:1814-1820. [PMID: 35657379 DOI: 10.1016/j.gim.2022.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 11/18/2022] Open
Abstract
Although still in the early stages of development, the advent of fast, high-output, and cost-effective next-generation DNA sequencing technology is moving precision medicine into public health. Before this shift toward next-generation sequencing in public health settings, individual patients met geneticists after showing symptoms and through limited family screening. In the new era of precision public health, everyone is a possible participant in genetic sequencing, simply by being born (newborn screening), by donating blood (biobanking), or through population screening. These initiatives are increasingly offered to individuals throughout their life and more individuals are encountering opportunities to use DNA sequencing. This article raises awareness of these growing areas and calls for different models of public engagement and communication about genomics, including screening asymptomatic populations, obtaining consent for unspecified and unforeseen future uses of genomic data, and managing variants of uncertain significance. Given that such communication challenges loom large, established norms of practice in genomic medicine and research should be reconsidered.
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Affiliation(s)
- Aviad Raz
- Department of Sociology & Anthropology, Ben-Gurion University of the Nagev, Beersheba, Israel.
| | | | - Gil Eyal
- Precision Medicine & Society Program, Department of Sociology, Columbia University, New York, NY
| | - Kyle Brothers
- Department of Pediatrics, School of Medicine, University of Louisville, Louisville, KY
| | - Jusaku Minari
- Uehiro Research Division for iPS Cell Ethics, Center for iPS Cell Research and Application (CiRA), Kyoto University, Kyoto, Japan
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6
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Berghs M. Let's Get Back to Normal? COVID-19 and the Logic of Cure. FRONTIERS IN SOCIOLOGY 2022; 7:782582. [PMID: 35495570 PMCID: PMC9039617 DOI: 10.3389/fsoc.2022.782582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 03/17/2022] [Indexed: 06/14/2023]
Abstract
The COVID-19 pandemic has inversed certainties of absolutes of cure in everyday life but paradoxically this has occurred during a time when novel scientific advancements seem to herald a new frontier of cures for rare diseases, chronic conditions, disabilities and viruses that were previously incurable. In this paper, I illustrate the development of a logic of cure by first of all noting a lacuna in the medical sociological and anthropological literature, where although a lot of empirical research and theoretical work to understand cure has been undertaken, there has been no sociology or anthropology of cure. Using three case studies, I examine what they reveal about the logic of cure. Firstly, I argue that there is a development of a bioethics of cure in reactions of disability community and disabled people to care as cure during the COVID-19 pandemic. The second case-study focuses on understanding limitations of vaccines and how people react against such indeterminancies of loss of absolutes of cure. Lastly, the final case study describes how while there are cures, for example, for rare genetic conditions, they are often initially curated with long-term cost-benefit analysis for the Global North. In conclusion, it is found that many of the developments within sociology and anthropology are missing from a logic of cure and that a new theory of cure has to develop.
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7
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Gobo G, Marcheselli V. Medicine and Biotechnologies. SCIENCE TECHNOLOGY AND SOCIETY 2022. [DOI: 10.1007/978-3-031-08306-8_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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8
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Heinsen LL, Wahlberg A, Petersen HV. Surveillance life and the shaping of 'genetically at risk' chronicities in Denmark. Anthropol Med 2021; 29:29-44. [PMID: 34254842 DOI: 10.1080/13648470.2021.1893654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Today, in the field of hereditary colorectal cancer in Denmark, more than 40,000 identified healthy individuals with an increased risk of cancer are enrolled in a surveillance program aimed at preventing cancer from developing, with numbers still growing. What this group of healthy individuals has in common is lifelong regular interaction with a healthcare system that has traditionally been geared towards treating the acutely and chronically ill. In this article, we explore how people living with an inherited elevated risk of colorectal cancer orient themselves towards their families' and their own predispositions as well as the lifelong surveillance trajectories that they have embarked upon - what we call surveillance life. Unlike prior critiques of predictive genetic testing as generative of 'pre-patients' or 'pre-symptomatically ill', we suggest that for those enrolled in lifelong surveillance programmes in welfare state Denmark, the relevance of risk fluctuates according to certain moments in life, e.g. at family reunions, when a close relative falls ill, in the time leading up to a surveillance colonoscopy or when enduring the procedures themselves. As such, rather than characterising surveillance life in terms of 'living with chronic risk' we show how 'genetically at risk' chronicities take shape as persons come to terms with a disease that possibly awaits them leading them to recalibrate familial bonds and responsibilities while leading lives punctuated by regular medical check-ups.
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Affiliation(s)
| | - Ayo Wahlberg
- Department of Anthropology, University of Copenhagen, Denmark
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9
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Mannette R. Navigating a world of genes: A conceptual analysis of gene fetishism, geneticization, genetic exceptionalism and genetic essentialism. Eur J Med Genet 2021; 64:104232. [PMID: 33974995 DOI: 10.1016/j.ejmg.2021.104232] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 04/21/2021] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
Genetics, as a discipline, is an essential part of the modern world. However, analyzing the interaction between genetics and society can be complex. Therefore, terminology has arisen from diverse fields to better understand genetics and its relation to other domains. Nevertheless, the diverse origins of many of these terms, as well as a lack of clarity in their definitions, have led to differences in use. This paper focuses on four such terms: genetic fetishism, geneticization, genetic essentialism, and genetic exceptionalism. By clarifying what each term means, the fields that utilize them will be helped. Furthermore, these terms can have specific value to bioethics in analyzing ethical issues that arise from genetics and the interaction with the socio-cultural world. While these terms may not always be applicable, a more careful analysis of their meaning can cultivate a more scientific and rigorous analysis of the ways genetics impacts and is understood by humanity.
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Affiliation(s)
- Ruel Mannette
- Department of Philosophy, University of Hawaii at Manoa, Honolulu, HI, USA.
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10
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Smilan LE. The Revised Common Rule and Mental Illness: Enduring Gaps in Protections. AMERICAN JOURNAL OF LAW & MEDICINE 2020; 46:413-444. [PMID: 33413011 DOI: 10.1177/0098858820975532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Lisa E Smilan
- Lisa E. Smilan, Visiting Scholar, Institute of Law, Psychiatry, and Public Policy, University of Virginia, Charlottesville, VA; J.D., George Washington University Law School, Washington, D.C.; LL.M., specialization in health law, University of Maryland Francis King Carey School of Law, Baltimore, MD; Member, National Institutes of Health Intramural Institutional Review Board, Bethesda, MD. The opinions here expressed are those of the Author and completely independent of the National Institutes of Health. The Author thanks Ellen Wright Clayton for supporting this scholarship and for comments on earlier drafts. Thanks, also, to Leslie Meltzer Henry for her guidance and encouragement, and both Richard Bonnie and Xuemei Ding for their hospitality at the University of Virginia and for facilitating access to university libraries. Finally, thanks to the anonymous peer reviewers for their observations, probing questions, and helpful suggestions, and AJLM editors Jessa Boubker and Sharon Jaquez for their dedication and meticulous care in preparing this Article for publication
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11
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Mikami K. Citizens under the umbrella: citizenship projects and the development of genetic umbrella organizations in the USA and the UK. NEW GENETICS AND SOCIETY 2020; 39:148-172. [PMID: 32406397 PMCID: PMC7195175 DOI: 10.1080/14636778.2019.1693889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 10/09/2019] [Indexed: 06/11/2023]
Abstract
Social scientists have observed previously that patient support groups began to have significant influence over both research and clinical services of medical genetics in the early 2000s. This observation led to the idea of genetic citizenship, suggesting that the active participation and intervention of patient support groups in the rapidly growing field of medicine marked the emergence of a new form of citizenship. To understand how this citizenship emerged, this paper examines the development of umbrella organizations of genetic support groups in the USA and the UK. The historical analysis demonstrates that the ways in which these organizations developed differ considerably, and that their visions and activities reflected the different structural and cultural organizations of medical genetics in their respective countries. By recognizing the early work of these organizations as citizenship projects, this article argues that they helped rather different forms of genetic citizenship to emerge in the two countries.
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Affiliation(s)
- Koichi Mikami
- Faculty of Science and Technology, Keio University, Kanagawa, Japan
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12
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Faure MC, Matshabane OP, Marshall P, Appelbaum PS, Stein DJ, Engel ME, de Vries J. Does genetics matter for disease-related stigma? The impact of genetic attribution on stigma associated with rheumatic heart disease in the Western Cape, South Africa. Soc Sci Med 2019; 243:112619. [PMID: 31715540 DOI: 10.1016/j.socscimed.2019.112619] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 10/14/2019] [Accepted: 10/17/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION A common concern in African genomic research is that such work may cause, or increase, stigma associated with particular diseases or population groups. While there is some evidence suggesting that genetic attribution of disease might impact stigma, there exists no evidence for the situation in African populations. With increasing genomic research in African populations, questions about the effect of genetic attribution on disease-related stigma are salient for stakeholders involved in implementation and regulation. To understand better the relationship between stigma and genetic attribution, we interviewed people with Rheumatic Heart Disease (RHD) in the Western Cape of South Africa. METHOD We conducted 11 focus group discussions with RHD patients of mixed-ancestry in the Western Cape, exploring the impact of genetic attribution on stigma. Participants had previously consented to participate in genomic research, attending information sessions on genetics. We explored the impact of genetic attribution by introducing both genetic and environmental causes to RHD and by specifically probing how these various causes would likely impact selected features of disease stigma. RESULTS Participants reported varying experiences of stigma relating to RHD, such as labelling, social exclusion and discrimination at the workplace. They had some understanding of genetics, either in general, or in relation to their illness. Participants' understanding depicted multiple causal models to explain RHD including genetic, environmental and bacterial causation. Overall, participants did not make a connection between genetics as a cause of RHD and their experiences of stigma. DISCUSSION In this study we found no support for the concern that genetic attribution of RHD, understood by participants in our study as a genetic predisposition to developing the disease, would impact stigma associated with it. Our findings provide some reassurance that genomic research may be unlikely to cause an increase in disease-related stigma in the South African context.
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Affiliation(s)
- Marlyn C Faure
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - Olivia P Matshabane
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | | | | | - Dan J Stein
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - Mark E Engel
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - Jantina de Vries
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
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13
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A task that remains before us: Reconsidering inheritance as a biosocial phenomenon. Semin Cell Dev Biol 2019; 97:189-194. [PMID: 31301355 DOI: 10.1016/j.semcdb.2019.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/07/2019] [Accepted: 07/08/2019] [Indexed: 11/20/2022]
Abstract
What doesit mean to inherit? Debates about the meaning of inheritance are numerous in the history and the present of the biological and the social sciences. While the majority of contributions in this special issue discuss hitherto unthought of molecular mechanisms of biological inheritance, this review explores the contested territory of inheritance from a social science perspective. Specifically, it examines contemporary biological research on epigenetic forms of inheritance in its historical and social contexts. To that end, the review explores what biology itself has been inheriting when it comes to how it considers inheritance conceptually and experimentally. I delineate three particularly important strands of inheritance: inheriting a history of eugenics; inheriting determinist reasoning; and inheriting experimental reductionism. I approach the social and scientific meaning of these inheritances by following scholars such as Donna Haraway and Jacques Derrida, who frame inheritance not as a passive occurrence but as an active process, as a task that must be undertaken by those who inherit. Such a framing raises the question of what it might mean to inherit something responsibly - particularly when what needs to be inherited is not an object but a difficult history. I argue that in order to become 'response-able' to this question, researchers who investigate biological inheritance today must engage these histories critically and review their legacies in present-day research. This is a task biologists might not want to undertake alone, but in interdisciplinary collaboration with social scientists and humanities scholars, in order to mobilize multiple forms of expertise for understanding the complex biosocial processes of human inheritance.
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Milne R. The rare and the common: scale and the genetic imaginary in Alzheimer's disease drug development. NEW GENETICS AND SOCIETY 2019; 39:101-126. [PMID: 32256202 PMCID: PMC7077363 DOI: 10.1080/14636778.2019.1637718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 06/03/2019] [Indexed: 06/11/2023]
Abstract
In this paper I examine how the promissory value of genetics is constituted through processes of scale and scaling, focussing on the relationship between "rare" and "common" forms of disease. I highlight the bodies and spaces involved in the production of post-genomic knowledge and technologies of Alzheimer's disease and the development of new disease-modifying drugs. I focus on the example of the development of a monoclonal antibody therapy for Alzheimer's disease. I argue that the process of therapeutic innovation, from genetic studies and animal models to phase III clinical trials, reflects the persistent importance of a genetic imaginary and a mutually constitutive relationship between the rare and the common in in shaping visions of Alzheimer's disease medicine. Approaching this relationship as a question of scale, I suggest the importance of attending to how and where genomic knowledge is "scaled" or proves resistant to scaling.
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Affiliation(s)
- Richard Milne
- Wellcome Genome Campus – Society and Ethics Research Group, Cambridge, UK
- Institute of Public Health, University of Cambridge, Cambridge, UK
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15
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Beaudevin C, Peerbaye A, Bourgain C. 'It has to become true genetics': tumour genetics and the division of diagnostic labour in the clinic. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41:643-657. [PMID: 30671989 DOI: 10.1111/1467-9566.12844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Tumour genetics is currently turning into a massive clinical approach. This paper is an enquiry into its practices as they expand beyond expert and experimental contexts and become routinised in clinical hospital settings. Studying a French university hospital, we unpack the content and everyday organization of diagnostic labour in this context. Exploring the sociotechnical frictions that arise in the process, we describe the ways in which they are collectively controlled, and stabilized through organizational fictions, that are instrumental in making tumour genetics doable in the hospital, at a large scale. We further show that the new role of external regulations in the production of clinical values for mutations has a strong impact on diagnostic work, making it possible to be performed locally without resorting to expert bioclinical collectives, and outside the professional jurisdiction of clinical geneticists. This division of labour appears as a necessary condition for the rise in clinical productivity required by a new function assigned to genetics: to guide the prescription of drugs for common diseases. This turn in the way genetics is embedded in the clinic calls for a thorough reassessment of its impacts on clinical discourses, practices and decisions.
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Affiliation(s)
- Claire Beaudevin
- CNRS (French National Centre for Scientific Research) / Cermes3 (Centre for research in medicine, science, health, mental health, and society), Villejuif/Paris, France
| | - Ashveen Peerbaye
- Paris-Est Marne-la-Vallée University, Laboratoire Interdisciplinaire Sciences Innovations Sociétés (LISIS), Marne-la-Vallée, France
| | - Catherine Bourgain
- Inserm (French Institute for Medical Research) / Cermes3 (Centre for research in medicine, science, health, mental health, and society), Villejuif/Paris, France
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16
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Intersections of health and gender imperatives: stratified decision-making among women with a BRCA mutation. BIOSOCIETIES 2019. [DOI: 10.1057/s41292-019-00154-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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17
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Dingel MJ, Ostergren J, Koenig BA, McCormick J. "Why did I get that part of you?" Understanding addiction genetics through family history. PUBLIC UNDERSTANDING OF SCIENCE (BRISTOL, ENGLAND) 2019; 28:53-67. [PMID: 29947292 PMCID: PMC6342673 DOI: 10.1177/0963662518785350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Scientists have sought to uncover the genetic bases of many diseases and disorders. In response, scholars defined "geneticization" to describe genetic infiltration of understandings of health and illness. In our research, we interviewed 63 individuals in addiction treatment programs to identify what form of geneticization best fits individuals' description of their own addiction. Individuals' narratives of their lives, which include family history and are influenced by cultural and structural factors, affect respondents' reactions to a potential genetic basis of addiction. Most who had a family history of addiction subscribed to a notion that addiction "runs in families," while most who lacked a family history of addiction used this fact to reject the notion of genetic inheritance of addiction. We conclude that though we see elements of several different versions of geneticization, Nikolas Rose's version, that genetics affects peoples' perceptions of addiction in small but important ways, best describes our respondents' views.
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Fournier T, Poulain JP. Eating According to One's Genes? Exploring the French Public's Understanding of and Reactions to Personalized Nutrition. QUALITATIVE HEALTH RESEARCH 2018; 28:2195-2207. [PMID: 30132729 DOI: 10.1177/1049732318793417] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In this article, we analyze qualitatively the understanding of and reactions to personalized nutrition (PN) among the French public. Focus groups were conducted to identify the opinions and discourses about two applications of knowledge from nutritional (epi)genomics: a biotechnology (nutrigenetic testing) and a public awareness campaign (the "first thousand days of life" initiative). Our objective was to understand to what extent PN could lead to changes in eating practices as well as in the representations of food-health relationships within France, a country characterized by a strong commitment to commensality and a certain "nutritional relativism." Although discourses on nutritional genomics testify to a resistance to food medicalization, nutritional epigenomics appears as more performative because it introduces the question of transgenerational transmission, thus parental responsibility.
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Affiliation(s)
- Tristan Fournier
- 1 Institut de Recherche Interdisciplinaire sur les enjeux Sociaux (Iris), Centre National de la Recherche Scientifique (CNRS), Paris, France
| | - Jean-Pierre Poulain
- 2 Université de Toulouse, Toulouse, France
- 3 Centre d'Etude et de Recherche Travail Organisation Pouvoir (Certop), Centre National de la Recherche Scientifique (CNRS), Toulouse, France
- 4 Laboratoire International Associé (LIA) "Food, Cultures and Health", Centre National de la Recherche Scientifique (CNRS), Taylor's University, Subang Jaya, Malaysia
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Penkler M, Müller R. [Not Available]. BERICHTE ZUR WISSENSCHAFTSGESCHICHTE 2018; 41:258-278. [PMID: 32495359 DOI: 10.1002/bewi.201801902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Michael Penkler
- Munich Center for Technology in Society, Technische Universität München, Arcisstraße 21, D-, 80333, München
| | - Ruth Müller
- Munich Center for Technology in Society, Technische Universität München, Arcisstraße 21, D-, 80333, München
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Meloni M, Müller R. Transgenerational epigenetic inheritance and social responsibility: perspectives from the social sciences. ENVIRONMENTAL EPIGENETICS 2018; 4:dvy019. [PMID: 30090643 PMCID: PMC6070063 DOI: 10.1093/eep/dvy019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/29/2018] [Accepted: 05/10/2018] [Indexed: 05/03/2023]
Abstract
Research in environmental epigenetics explores how environmental exposures and life experiences such as food, toxins, stress or trauma can shape trajectories of human health and well-being in complex ways. This perspective resonates with social science expertise on the significant health impacts of unequal living conditions and the profound influence of social life on bodies in general. Environmental epigenetics could thus provide an important opportunity for moving beyond long-standing debates about nature versus nurture between the disciplines and think instead in 'biosocial' terms across the disciplines. Yet, beyond enthusiasm for such novel interdisciplinary opportunities, it is crucial to also reflect on the scientific, social and political challenges that a biosocial model of body, health and illness might entail. In this paper, we contribute historical and social science perspectives on the political opportunities and challenges afforded by a biosocial conception of the body. We will specifically focus on what it means if biosocial plasticity is not only perceived to characterize the life of individuals but also as possibly giving rise to semi-stable traits that can be passed on to future generations. That is, we will consider the historical, social and political valences of the scientific proposition of transgenerational epigenetic inheritance. The key question that animates this article is if and how the notion of transgenerational epigenetic inheritance creates new forms of responsibilities both in science and in society. We propose that, ultimately, interdisciplinary conversation and collaboration is essential for responsible approaches to transgenerational epigenetic inheritance in science and society.
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Affiliation(s)
- Maurizio Meloni
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, Melbourne, VIC, Australia
| | - Ruth Müller
- Munich Center for Technology in Society (MCTS), Technical University of Munich, Augustenstraße 46, Munich, Germany
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Damasceno ÉDB, Figueiredo JGD, França JMB, Veras JCD, Borges REA, Melo LPD. Experiência de pessoas que vivem com a Síndrome de Berardinelli-Seip no Nordeste brasileiro. CIENCIA & SAUDE COLETIVA 2018; 23:389-398. [DOI: 10.1590/1413-81232018232.16802017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 08/27/2017] [Indexed: 11/21/2022] Open
Abstract
Resumo O artigo analisa a experiência de pessoas que vivem com a Síndrome de Berardinelli-Seip no Nordeste brasileiro. Este estudo qualitativo foi desenvolvido com onze interlocutores, sendo nove pessoas vivendo com a síndrome e duas mães. Para coligir as informações, utilizaram-se observação participante, caracterização social e entrevistas semiestruturadas. Os dados foram analisados por meio da técnica de codificação temática. Emergiram duas categorias: (1) ‘o segredo é fechar a boca’: gerenciamento da alimentação na vida cotidiana; e (2) ‘ah, é uma travesti?’ Corpo, gênero e masculinização. Concluiu-se que na experiência dos interlocutores seus agenciamentos e criatividade se traduziram em estratégias para gerenciamento da alimentação que integravam gostos, valores, hábitos, prescrições biomédicas e prazeres envolvidos em situações de comensalidade. No que tange à corporeidade, evidenciou-se que as representações e as experiências com o corpo apresentam desigualdades de gênero, na medida em que a mulher passa a ser alvo privilegiado de estigmas, preconceitos e discriminação na vida adulta.
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Dingel MJ, Ostergren J, Heaney K, Koenig BA, McCormick J. "I don't have to know why it snows, I just have to shovel it!": Addiction Recovery, Genetic Frameworks, and Biological Citizenship. BIOSOCIETIES 2017; 12:568-587. [PMID: 29552089 PMCID: PMC5851475 DOI: 10.1057/s41292-017-0045-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The gene has infiltrated the way citizens perceive themselves and their health. However, there is scant research that explores the ways genetic conceptions infiltrate individuals' understanding of their own health as it relates to a behavioral trait, like addiction. Do people seeking treatment for addiction ground their self-perception in biology in a way that shapes their experiences? We interviewed 63 participants in addiction treatment programs, asking how they make meaning of a genetic understanding of addiction in the context of their recovery, and in dealing with the stigma of addiction. About two-thirds of people in our sample did not find a genetic conception of addiction personally useful to them in treatment, instead believing that the cause was irrelevant to their daily struggle to remain abstinent. One-third of respondents believed that an individualized confirmation of a genetic predisposition to addiction would facilitate their dealing with feelings of shame and accept treatment. The vast majority of our sample believed that a genetic understanding of addiction would reduce the stigma associated with addiction, which demonstrates the perceived power of genetic explanations in U.S. society. Our results indicate that respondents (unevenly) ground their self-perception of themselves as an addicted individual in biology.
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Affiliation(s)
- Molly J Dingel
- University of Minnesota Rochester, 300 University Square, 111 South Broadway, Rochester, Minnesota, 55904, USA, , (507) 258-8206
| | - Jenny Ostergren
- University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, Michigan, USA,
| | - Kathleen Heaney
- Hennepin County Medical Center, 701 Park Avenue, Minneapolis, Minnesota, USA,
| | - Barbara A Koenig
- University of California, San Francisco, Institute for Health & Aging, 3333 Calif. St, Laurel Heights, San Francisco CA 94143,
| | - Jennifer McCormick
- Pennsylvania State University, 1743C Humanities, Hershey Medical Center, Hershey, PA 17033
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23
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Weiner K, Martin P, Richards M, Tutton R. Have we seen the geneticisation of society? Expectations and evidence. SOCIOLOGY OF HEALTH & ILLNESS 2017; 39:989-1004. [PMID: 28271518 DOI: 10.1111/1467-9566.12551] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Abby Lippman's geneticisation thesis, of the early 1990s, argued and anticipated that with the rise of genetics, increasing areas of social and health related activities would come to be understood and defined in genetic terms leading to major changes in society, medicine and health care. We review the considerable literature on geneticisation and consider how the concept stands both theoretically and empirically across scientific, clinical, popular and lay discourse and practice. Social science scholarship indicates that relatively little of the original claim of the geneticisation thesis has been realised, highlighting the development of more complex and dynamic accounts of disease in scientific discourse and the complexity of relationships between bioscientific, clinical and lay understandings. This scholarship represents a shift in social science understandings of the processes of sociotechnical change, which have moved from rather simplistic linear models to an appreciation of disease categories as multiply understood. Despite these shifts, we argue that a genetic imaginary persists, which plays a performative role in driving investments in new gene-based developments. Understanding the enduring power of this genetic imaginary and its consequences remains a key task for the social sciences, one which treats ongoing genetic expectations and predictions in a sceptical yet open way.
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Affiliation(s)
- Kate Weiner
- Department of Sociological Studies, University of Sheffield, UK
| | - Paul Martin
- Department of Sociological Studies, University of Sheffield, UK
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Hallowell N, Jenkins N, Douglas M, Walker S, Finnie R, Porteous M, Lawton J. A qualitative study of patients' perceptions of the value of molecular diagnosis for familial hypercholesterolemia (FH). J Community Genet 2017; 8:45-52. [PMID: 27866366 PMCID: PMC5222760 DOI: 10.1007/s12687-016-0286-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 11/02/2016] [Indexed: 12/27/2022] Open
Abstract
For many years, familial hypercholesterolemia (FH), an inherited disorder, has been diagnosed using phenotypic features plus family history of early onset cardiovascular disease (CVD), and has been successfully treated using statin therapy. DNA testing is now available and this has been incorporated into familial cascade screening programmes in many parts of Europe. Little is known about patients' perceptions of the value of undergoing molecular diagnosis for FH. In-depth interviews were carried out with patients (n = 38) being treated for FH who were the first in their family to undergo DNA testing for FH. Data were analysed thematically. While interviewees regarded DNA testing as an unexceptional event, it was seen as a positive innovation because it confirmed that their family carried a particular disorder, offered an aetiological explanation for their hypercholesterolemia and provided information about their own and family members' future risks. From the patient perspective, the main benefit of molecular diagnosis lies in its ability to provide information which allows (younger) family members to access genetic screening and, thus, timely treatment. The implications for future developments in genetic services and the need to investigate further the provision of molecular testing in mainstream specialties are briefly discussed.
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Affiliation(s)
- Nina Hallowell
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Nicholas Jenkins
- School of Media, Culture and Society, University of the West of Scotland, Edinburgh, UK
| | | | - Simon Walker
- Clinical Biochemistry, Division of Reproductive and Developmental Sciences, University of Edinburgh, Edinburgh, UK
| | | | | | - Julia Lawton
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
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26
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Gaille M. On prenatal diagnosis and the decision to continue or terminate a pregnancy in France: a clinical ethics study of unknown moral territories. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2016; 19:381-391. [PMID: 26864662 DOI: 10.1007/s11019-016-9689-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This article presents a part of the results of an empirical study conducted at a Parisian hospital between 2011 and 2014. It aimed at understanding the women and couples' motivations to terminate or not a pregnancy once a prenatal diagnosis has revealed a genetically related disease in the embryo or fetus. The article first presents the social and legal context of the study, the methodology used and the pathologies that were encountered. Then, it examines the results of the interviews conducted with 5 women alone and 23 couples explaining their reasons for deciding to terminate or not the pregnancy. Finally, it explores the patients' views about the doctor's involvement in the decision-making process. The findings reveal the reasons they formulate when they ponder whether to terminate or not the pregnancy. It highlights the process of their deliberation, their hierarchisation of arguments and concerns. They also show how patients, though often consumed in sorrow, claim to be the legitimate decision-makers, especially women, in a social and legal context in which the rejection of eugenics is viewed as an undisputable principle.
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Affiliation(s)
- Marie Gaille
- Laboratoire SPHERE, UMR 7219, CNRS-USPC, Université Paris Diderot, Bâtiment Condorcet, Case 7093, 5 rue Thomas Mann, 75205, Paris Cedex 13, France.
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Big Data, Small Talk: Lessons from the Ethical Practices of Interpersonal Communication for the Management of Biomedical Big Data. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/978-3-319-33525-4_13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
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Abstract
For too long, journal articles and textbooks on scientific and technical discourse have adopted a positivistic approach to visuals. Unfortunately, this approach is problematic. It ignores that visuals are constructions that are products of a writer's interpretation with its own power-laden agenda. For example, in representing a tamed and dominated nature, visuals become instruments of patriarchy. Reading them responsibly requires that we uncover some of the values attached to the strategies of creating visuals and to the objects created. This article reviews the current approach taken by composition scholars, surveys richer interdisciplinary work on visuals, and—by using visuals connected with the Human Genome Project—models an analysis of visuals as rhetoric.
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29
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Robert JS. Illich, Education, and the Human Genome Project: Reflections on Paradoxical Counterproductivity. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/027046769801800402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Human Genome Project (HGP) brings genetics and genetic knowledge to the point of paradoxical counterproductivity. Population-wide genetic screens, replacing specific tests intended for and useful to those at risk, become counterproductive when the HGP's "normal human " defines everybody as at risk. More over, the knowledge generated by the HGP disables those whom it is meant to serve: We are rendered impotent as a laity, subject to expertise regarding the truth of our being. The standard response here is that we need more science education and easier access to scientific knowledge. But that is simply to beg the question. The question to ask about knowledge is not whether it is true or properly scientific (which it may very well be) but rather whether it is good. The good of knowledge must be demonstrated and not uncritically assumed. Thus, more education can, too, be paradoxically counterproductive. What, then, are our prospects?
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Hogan AJ. Making the most of uncertainty: Treasuring exceptions in prenatal diagnosis. STUDIES IN HISTORY AND PHILOSOPHY OF BIOLOGICAL AND BIOMEDICAL SCIENCES 2016; 57:24-33. [PMID: 27010571 DOI: 10.1016/j.shpsc.2016.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 02/18/2016] [Accepted: 02/21/2016] [Indexed: 06/05/2023]
Abstract
Throughout the 20th century, human genetics research was driven by the identification of new variants. As pioneering geneticist William Bateson put it, novel variants were "exceptions" to "treasure". With the rise of human chromosomal analysis in the postwar period, the identification of genetic variants became increasingly significant to clinical and prenatal diagnosis. Human geneticists had long sought a broader sampling of human genetic variation, from a largely "normal" population. The expansion of prenatal diagnosis in the late 20th century offered a new resource for identifying novel genetic variants. In the prenatal diagnostic setting however, many of the exceptions to be treasured were of uncertain clinical significance, which raised anxiety among parents. In the early 1990s, providers reported that specific uncertain results from chorionic villus sampling (CVS) facilitated prenatal diagnoses that were not previously possible. Based on this, some prenatal diagnostic providers began to embrace uncertainty, when properly managed to reduce anxiety, rather than prevent it. The potential to produce uncertainty in prenatal diagnosis grew with whole genome microarray in the 2000s. Rather than outcomes to avoid, or accept as inevitable, providers presented uncertain results as starting points for research to improve the scope prenatal diagnosis, and bring future certainty.
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Affiliation(s)
- Andrew J Hogan
- Department of History, 225 Humanities, Creighton University, 2500 California Plaza, Omaha, NE 68178, USA.
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31
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Arribas-Ayllon M. After geneticization. Soc Sci Med 2016; 159:132-9. [DOI: 10.1016/j.socscimed.2016.05.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 05/04/2016] [Accepted: 05/05/2016] [Indexed: 11/24/2022]
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32
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Cabrera LY, Beattie BL, Dwosh E, Illes J. Converging approaches to understanding early onset familial Alzheimer disease: A First Nation study. SAGE Open Med 2015; 3:2050312115621766. [PMID: 27092264 PMCID: PMC4821204 DOI: 10.1177/2050312115621766] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 11/16/2015] [Indexed: 11/17/2022] Open
Abstract
Objectives: In 2007, a novel pathogenic genetic mutation associated with early onset familial Alzheimer disease was identified in a large First Nation family living in communities across British Columbia, Canada. Building on a community-based participatory study with members of the Nation, we sought to explore the impact and interplay of medicalization with the Nation’s knowledge and approaches to wellness in relation to early onset familial Alzheimer disease. Methods: We performed a secondary content analysis of focus group discussions and interviews with 48 members of the Nation between 2012 and 2013. The analysis focused specifically on geneticization, medicalization, and traditional knowledge of early onset familial Alzheimer disease, as these themes were prominent in the primary analysis. Results: We found that while biomedical explanations of disease permeate the knowledge and understanding of early onset familial Alzheimer disease, traditional concepts about wellness are upheld simultaneously. Conclusion: The analysis brings the theoretical framework of “two-eyed seeing” to the case of early onset familial Alzheimer disease for which the contributions of different ways of knowing are embraced, and in which traditional and western ways complement each other on the path of maintaining wellness in the face of progressive neurologic disease.
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Affiliation(s)
- Laura Y Cabrera
- National Core for Neuroethics, Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Center for Ethics and Humanities in the Life Sciences, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - B Lynn Beattie
- Division of Geriatric Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Clinic for Alzheimer Disease and Related Disorders, University of British Columbia, Vancouver, BC, Canada
| | - Emily Dwosh
- Clinic for Alzheimer Disease and Related Disorders, University of British Columbia, Vancouver, BC, Canada; Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Judy Illes
- National Core for Neuroethics, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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33
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Model homes for model organisms: Intersections of animal welfare and behavioral neuroscience around the environment of the laboratory mouse. BIOSOCIETIES 2015. [DOI: 10.1057/biosoc.2015.19] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Aureliano WDA. Health and the Value of Inheritance: The meanings surrounding a rare genetic disease. VIBRANT: VIRTUAL BRAZILIAN ANTHROPOLOGY 2015. [DOI: 10.1590/1809-43412015v12n1p109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In this article I explore the meanings acquired by the notion of 'genetic inheritance' for families in Rio de Janeiro affected by a rare hereditary disorder, Machado-Joseph disease. My analysis examines three points: 1) how experience of the disease was thematized in the family prior to knowledge of its genetic and hereditary origin; 2) how knowledge of genetics affected the family's perception of their health and reproduction through the notion of risk contained in medical explanations; 3) finally, I problematize the meanings of 'hope,' a sentiment frequently cited by people with the disease and their descendants. Notably, despite the high value attributed to science and 'medical progress,' the use of certain biotechnologies is not always seen as positive or capable of enabling choices and actions in response to a rare disease. Notions of risk, responsibility and hope thus acquire singular contours for managing life and the continuity of the family.
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35
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Abstract
Searching and finding supposedly anonymous sperm donors or half-siblings by diverting direct-to-consumer genetic testing is a novel phenomenon. I refer to such new forms of kinship as 'wayward relations,' because they are often officially unintended and do not correspond to established kinship roles. Drawing on data mostly from the United Kingdom, Germany and the United States, I argue that wayward relations are a highly contemporary means of asserting agency in a technological world characterized by tensions over knowledge acquisition. I make the case that such relations reaffirm the genetic grounding of kinship, but do not displace other ways of relating--they are complementary not colonizing. Wayward relations challenge the gate-keeper status of fertility clinics and regulators over genetic knowledge and classical notions of privacy.
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Affiliation(s)
- Maren Klotz
- a Department of European Ethnology , Humboldt University , Berlin , Germany
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36
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Cheung BY, Dar-Nimrod I, Gonsalkorale K. Am I My Genes? Perceived Genetic Etiology, Intrapersonal Processes, and Health. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2014. [DOI: 10.1111/spc3.12138] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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37
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Healthy citizenship beyond autonomy and discipline: Tactical engagements with genetic testing. BIOSOCIETIES 2014. [DOI: 10.1057/biosoc.2014.29] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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38
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Phelan JC, Link BG, Zelner S, Yang LH. Direct-to-Consumer Racial Admixture Tests and Beliefs About Essential Racial Differences. SOCIAL PSYCHOLOGY QUARTERLY 2014; 77:296-318. [PMID: 25870464 DOI: 10.1177/0190272514529439] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although at first relatively disinterested in race, modern genomic research has increasingly turned attention to racial variations. We examine a prominent example of this focus-direct-to-consumer racial admixture tests-and ask how information about the methods and results of these tests in news media may affect beliefs in racial differences. The reification hypothesis proposes that by emphasizing a genetic basis for race, thereby reifying race as a biological reality, the tests increase beliefs that whites and blacks are essentially different. The challenge hypothesis suggests that by describing differences between racial groups as continua rather than sharp demarcations, the results produced by admixture tests break down racial categories and reduce beliefs in racial differences. A nationally representative survey experiment (N = 526) provided clear support for the reification hypothesis. The results suggest that an unintended consequence of the genomic revolution may be to reinvigorate age-old beliefs in essential racial differences.
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Affiliation(s)
| | - Bruce G Link
- Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Sarah Zelner
- University of Pennsylvania, Philadelphia, PA, USA
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39
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Bitsch L, Stemerding D. The innovation journey of genomics and asthma research. SOCIOLOGY OF HEALTH & ILLNESS 2013; 35:1164-1180. [PMID: 23551185 DOI: 10.1111/1467-9566.12028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This article concerns the transformative potential of medical genomics for common disease research. We analysed 13 review articles in asthma research in the period 1999 to 2008. Our aim was to understand how genomics has emerged in this research field, and the attendant changes. Motivated by Lippman's geneticisation thesis, we use the concept of an 'innovation journey' to trace how expectations of improved understanding, prevention, diagnosis and treatment structure a dynamic co-evolutionary process through which a genome-based discourse emerges. We show how the asthma researchers involved continuously struggle to define their contribution to asthma research, as well as to clinical practice. Along the way, the researchers propose changes to both the definition and the aetiological model of asthma, thus highlighting gene-gene and gene-environment interactions. It is, however, difficult to characterise this discourse as one of geneticisation. With increasing attention being given to epigenetics, metabolomics, proteomics and systems biology, the emerging picture suggests an important, but much less deterministic, role for genes.
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Affiliation(s)
- Lise Bitsch
- Department of Science, Technology and Policy Studies (STePS), University of Twente, The NetherlandsTechnology Assessment, The Rathenau Institute, The Hague, The Netherlands
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40
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Trundle C, Scott BI. Elusive Genes: Nuclear Test Veterans’ Experiences of Genetic Citizenship and Biomedical Refusal. Med Anthropol 2013; 32:501-17. [DOI: 10.1080/01459740.2012.757606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
What is psychiatry? Such a question is increasingly important to engage with in light of the development of new diagnostic frameworks that have wide-ranging and international clinical and societal implications. I suggest in this reflective essay that 'psychiatry' is not a singular entity that enjoins consistent forms of critique along familiar axes; rather, it is a heterogeneous assemblage of interacting material and symbolic elements (some of which endure, and some of which are subject to innovation). In underscoring the diversity of psychiatry, I seek to move towards further sociological purchase on what remains a contested and influential set of discourses and practices. This approach foregrounds the relationships between scientific knowledge, biomedical institutions, social action and subjective experience; these articulations co-produce both psychiatry and each other. One corollary of this emphasis on multiplicity and incoherence within psychiatric theory, research and practice, is that critiques which elide this complexity are rendered problematic. Engagements with psychiatry are, I argue, best furthered by recognising its multifaceted nature.
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Affiliation(s)
- Martyn Pickersgill
- Centre for Population Health Sciences, University of Edinburgh . E-mail:
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42
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Cox H, Webster A. Translating biomedical science into clinical practice: Molecular diagnostics and the determination of malignancy. Health (London) 2012; 17:391-406. [PMID: 23074299 DOI: 10.1177/1363459312460701] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Helen Cox
- Department of Health Sciences, University of York, York, YO10 5DD, UK.
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Easter MM. "Not all my fault": genetics, stigma, and personal responsibility for women with eating disorders. Soc Sci Med 2012; 75:1408-16. [PMID: 22819736 DOI: 10.1016/j.socscimed.2012.05.042] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 05/29/2012] [Accepted: 05/31/2012] [Indexed: 01/16/2023]
Abstract
Medical researchers and clinicians increasingly understand and present eating disorders (anorexia and bulimia nervosa) as biologically-based psychiatric disorders, with genetic risk factors established by high heritability estimates in twin studies. But there has been no research on interpretation of genetic involvement by people with eating disorders, who may hold other views. Their interpretations are particularly important given the frequent presumption that biogenetic framing will reduce stigma, and recent findings that it exacerbates stigma for other mental illnesses. To identify implications of genetic framing in eating disorders, I conducted semi-structured interviews with 50 US women with a history of eating disorders (half recovered, half in treatment; interviewed 2008-9 in the USA). Interviews introduced the topic of genetics, but not stigma per se. Analysis followed the general principles of grounded theory to identify perceived implications of genetic involvement; those relevant to stigma are reported here. Most anticipated that genetic reframing would help reduce stigma from personal responsibility (i.e., blame and guilt for eating disorder as ongoing choice). A third articulated ways it could add stigma, including novel forms of stigma related to genetic-essentialist effacing of social factors. Despite welcoming reductions in blame and guilt, half also worried genetic framing could hamper recovery, by encouraging fatalistic self-fulfilling prophecies and genetic excuses. This study is the first to elicit perceptions of genetic involvement by those with eating disorders, and contributes to an emerging literature on perceptions of psychiatric genetics by people with mental illness.
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Affiliation(s)
- Michele M Easter
- Genome Ethics, Law & Policy, Institute for Genome Sciences & Policy, Duke University, Box 90141, Durham, NC 27708, USA.
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Tentative (id)entities: On technopolitical cultures and the experiencing of genetic testing. BIOSOCIETIES 2011. [DOI: 10.1057/biosoc.2011.5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Laegsgaard MM, Stamp AS, Hall EOC, Mors O. The perceived and predicted implications of psychiatric genetic knowledge among persons with multiple cases of depression in the family. Acta Psychiatr Scand 2010; 122:470-80. [PMID: 20346073 DOI: 10.1111/j.1600-0447.2010.01555.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Psychiatric genetic research raises hope regarding better treatment and prevention, but also regarding a possible de-stigmatizing effect of attributing mental illness to genetics. This study explores i) the impact on family relations of participating in a genetic study; ii) the impact of biogenetic attributions on perceptions of depression and stigma and iii) the perceived benefits and concerns regarding psychiatric genetic testing. METHOD Focus groups were conducted with 17 participants suffering from depression, with multiple cases of depression in the family, and previously participating in a genetic study. RESULTS Participating in a genetic study caused more openness about depression in most families. A biogenetic explanation of depression was perceived as having the potential of diminishing self stigma. Testing of self and children was widely accepted, whereas prenatal testing raised concern. CONCLUSION Persons suffering from depression may benefit from endorsing a biogenetic explanation, especially in relation to self-understanding and self-stigma.
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Affiliation(s)
- M M Laegsgaard
- Centre for Psychiatric Research, Aarhus Psychiatric University Hospital, Risskov, Denmark.
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The practical ethics of genetic responsibility: Non-disclosure and the autonomy of affect. SOCIAL THEORY & HEALTH 2010. [DOI: 10.1057/sth.2009.22] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Pickersgill MD. Psyche, soma, and science studies: New directions in the sociology of mental health and illness. J Ment Health 2010; 19:382-92. [DOI: 10.3109/09638230903531092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Metzler I. Biomarkers and their consequences for the biomedical profession: a social science perspective. Per Med 2010; 7:407-420. [PMID: 29788645 DOI: 10.2217/pme.10.41] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Although biomarkers are not altogether new, they are gaining a new life in our postgenomic present. This article takes this as a good reason to explore biomarkers in depth and to speculate about the consequences that biomarkers might engender in clinical practices. First, the article ventures into an endeavor of ordering the dynamic field of biomarkers, suggesting a possible classification of biomarkers, and then argues that we are currently witnessing a 'biomarkerization' of health and disease - defined as an ongoing future-oriented process that seeks to solve biomedical as well as public health problems through investments into biomarker research at the present time. Subsequently, this article reflects on some possible consequences of this phenomenon. It argues that while the movement of candidate biomarkers into the clinic is arduous, biomarkers might develop a life of their own once they arrive in the clinic. This article outlines the direction of two such possible consequences. It suggests that biomarkers might be involved in a change of the actors that order and categorize diseases, as well as trigger transformations in our understanding of what counts as disease in the first place. Hence, this article seeks to shed light on the paradox that while biomarkers are designed to add more evidence into clinical practice, they might actually increase uncertainty and ambiguity.
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Affiliation(s)
- Ingrid Metzler
- Life-Science-Governance Research Platform, University of Vienna, Department of Political Science, Universitaetsstr. 7/2, A-1010 Vienna, Austria.
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Lindsay S. Exploring the role of family history and lay understanding of genetics on the self-management of disease. ACTA ACUST UNITED AC 2010. [DOI: 10.1111/j.1752-9824.2010.01052.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Seabrook JA, Avison WR. Genotype–environment interaction and sociology: Contributions and complexities. Soc Sci Med 2010; 70:1277-84. [DOI: 10.1016/j.socscimed.2010.01.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Revised: 12/15/2009] [Accepted: 01/12/2010] [Indexed: 02/01/2023]
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