Detaching data from the state: Biobanking and building Big Data in Sweden

Population curation: The construction of mutual obligation between individual and state in Danish precision medicine

How do precision medicine initiatives (re)organize relations between individuals and populations? In this article, we investigate how the curation of national genomic populations enacts communities and, in so doing, constructs mutual obligation between individuals and the state. Drawing on ethnographic fieldwork in the Danish National Genome Center (DNGC), we show how members of advisory bodies negotiated the inclusion criteria for two different genomic populations: a patient genome population and an envisioned 'Danish' reference genome population. The patient genome population was curated through a politics of inclusion, of as many genomes as possible, whereas the reference genome was to be curated through a politics of exclusion, to include only the genomes of 'ethnic' Danes. These two data populations configure differently the community of 'Danish patients' who might benefit from precision medicine, and thereby prescribe different moral continuities between person, state, and territory. We argue that the DNGC's patient genome population reinforces reciprocal relations of obligations and responsibility between the Danish welfare state and all individuals, while the proposed Danish reference genome population privileges the state's commitment to individuals with biographical-territorial belonging to the nation-state. Drawing on scholarship on social and health citizenship, as well as data solidarity in the Nordics, the discussion shows how population curation in national precision medicine initiatives might both construct and stratify political obligation. Whereas STS scholarship has previously deconstructed the concept of 'population', in the context of the troubling and violent effects of the management of human populations, we point to the importance of population curation as a vehicle for making the individual legible as part of a community to which the state is responsible and for which it is committed to care.

Six decades of longitudinal health knowledge production: a systematic review on Nordic birth cohort studies

This systematic review (a) identifies birth cohort studies (BCSs) established in the Nordic countries, (b) describes their basic characteristics, and (c) explores how these characteristics have evolved over time, discussing their implications to knowledge production. To identify Nordic BCSs, cohort databases and relevant scientific articles were systematically searched and screened.The review shows that since 1959, more than 600,000 index children have participated in the 79 Nordic BCSs (22 Danish, 20 Finnish, 12 Norwegian, 24 Swedish, one Icelandic), over half of them still ongoing. The Nordic BCSs cover a wide geographical area including the Nordic Arctic. The topics of BCSs have varied over time but most have focused on examining the developmental origins of diseases. A quarter of them had a general scope, while the rest started with a specific focus, commonly atopic diseases. All BCSs collected questionnaire and/or interview data and over 60% of the BCSs announced exclusion criteria for participants, typically insufficient language proficiency.NBCSs have produced crucial scientific knowledge for over six decades, but there are underutilised opportunities including systematic interdisciplinary collaboration, inclusion of children's own views of their health and well-being, intergenerational data collection, and specific knowledge of Arctic indigenous peoples and other minorities.

A solidarity paradox - welfare state data in global health data economy

Nordic welfare states have well institutionalised practises of gathering health and social wellbeing data from their citizens. The establishment of population registers coincided with the building of welfare state institutions and a social contract relying on solidarity. During the last decade, the significance of Nordic registers and health data has increased and they have become sources of economic value. Recent policies expect registers, health data and biobanks to attract international investments, making Nordic countries world-leaders in the global health data economy. In this article we question the conditions and boundaries of solidarity in the emerging data-driven health economy. We argue that the logics of welfare state and data-driven health economy create a paradox - the data economy is not possible without the welfare state data regime, but the logic of data-driven health economy contradicts the value bases of the welfare state data regime and therefore the justifications for data gathering and use become questionable. We develop the concept of solidarization to describe the process by which individuals are expected to behave in a solidaristic way to support data gathering and related policy processes. We demonstrate the solidarity paradox through a recent legislative and data infrastructure reform in Finland and discuss it in relation to academic literature on solidarity.

Infrastructuring European scientific integration: Heterogeneous meanings of the European biobanking infrastructure BBMRI-ERIC

While transnational research infrastructure projects long preceded the formal integration process that created the European Union, their advancement is an increasingly central part of EU research policy and of European integration in general. This paper analyses the Biobanking and Biomolecular Resources Research Infrastructure-European Research Infrastructure Consortium (BBMRI-ERIC) as a recent example of institutionalized scientific collaboration in Europe that has formally been established as part of EU science policy. BBMRI-ERIC, a network of European biobanks, is expected to contribute to both European science and European integration. Yet its achievements in these domains are interpreted differently by various actors involved. This paper draws on STS conceptualizations of infrastructures as relational, experimental, and promissory assemblages. These support the formulation of a working definition of research infrastructures that in turn helps to explore the heterogeneous meanings attributed to BBMRI-ERIC. The paper describes the creation of this distributed European research infrastructure, and divergent understandings of what it means for BBMRI-ERIC to be distributed, to be European and to be a research infrastructure. This analysis demonstrates how building a research infrastructure is also an effort to define what it means to be European-a process in which what is European about science and what science can do for Europe is continuously (re-)imagined, contested and negotiated.

Privacy and Health Practices in the Digital Age

Increasing privacy concerns are arising from expanding use of aggregated personal information in health practices. Conversely, in light of the promising benefits of data driven healthcare, privacy is being frequently dismissed as outdated, costly and ultimately egotistical. This paper aims to review the theoretical framework on privacy in order to overcome the often simplistic debate between the primacy of individual or collective interests. As a result, it is argued that although privacy can be understood as freedom of personal choice in matters of sharing intimacy, it is foundational to both community belonging and to social and political organizations at large. Ethical decisions on the use of data analytics technologies in health practices should also take into account the social effects of violating privacy.

National Biobanking in Qatar and Israel: Tracing how Global Scientific Institutions Mediate Local Ethnic Identities

Biobanks are a growing phenomenon in global biomedicine, as they are key tools of precision medicine initiatives. National biobanks, however, collect data and biological material from populations in specific regions, and the knowledge that national biobanks yield can impact understandings of identity, origins and belonging. Drawing on ethnographic work and documentary analysis examining the Israeli and Qatari national biobanks, I find that these two Middle Eastern biobanks aim to contribute to global biobanking trends, while at the same time, they reinforce local ethnic and national identities. The Israeli biobank reflects pre-existing ethnic identities in Israeli society, while the Qatari biobank predominantly emphasises the emergent national character of the Qatari population. Neither of the biobanks assert a high genetic homogeneity of the national population; rather, they both emphasise a genetically diverse national cohort that is a valuable resource for biomedical research. Through a comparative analysis of global biobanking and ethnic identities, this article demonstrates that biobanks are a rich site for tracking emergent national identities in the Middle East region.

Data as promise: Reconfiguring Danish public health through personalized medicine

'Personalized medicine' might sound like the very antithesis of population science and public health, with the individual taking the place of the population. However, in practice, personalized medicine generates heavy investments in the population sciences - particularly in data-sourcing initiatives. Intensified data sourcing implies new roles and responsibilities for patients and health professionals, who become responsible not only for data contributions, but also for responding to new uses of data in personalized prevention, drawing upon detailed mapping of risk distribution in the population. Although this population-based 'personalization' of prevention and treatment is said to be about making the health services 'data-driven', the policies and plans themselves use existing data and evidence in a very selective manner. It is as if data-driven decision-making is a promise for an unspecified future, not a demand on its planning in the present. I therefore suggest interrogating how 'promissory data' interact with ideas about accountability in public health policies, and also with the data initiatives that the promises bring about. Intensified data collection might not just be interesting for what it allows authorities to do and know, but also for how its promises of future evidence can be used to postpone action and sidestep uncomfortable knowledge in the present.

Impossible, unknowable, accountable: Dramas and dilemmas of data law

On May 25, 2018, the European Union's General Data Protection Regulation (GDPR) came into force. EU citizens are granted more control over personal data while companies and organizations are charged with increased responsibility enshrined in broad principles like transparency and accountability. Given the scope of the regulation, which aims to harmonize data practices across 28 member states with different concerns about data collection, the GDPR has significant consequences for individuals in the EU and globally. While the GDPR is primarily intended to regulate tech companies, it also has important implications for data use in scientific research. Drawing on ethnographic fieldwork with researchers, lawyers and legal scholars in Sweden, I argue that the GDPR's flexible accountability principle effectively encourages researchers to reflect on their ethical responsibility but can also become a source of anxiety and produce unexpected results. Many researchers I spoke with expressed profound uncertainty about 'impossible' legal requirements for research data use. Despite the availability of legal texts and interpretations, I suggest we should take researchers' concerns about 'unknowable' data law seriously. Many researchers' sense of legal ambiguity led them to rethink their data practices and themselves as ethical subjects through an orientation to what they imagined as the 'real people behind the data', variously formulated as a Swedish population desiring data use for social benefit or a transnational public eager for research results. The intentions attributed to people, populations and publics - whom researchers only encountered in the abstract form of data - lent ethical weight to various and sometimes conflicting decisions about data security and sharing. Ultimately, researchers' anxieties about their inability to discern the desires of the 'real people' lent new appeal to solutions, however flawed, that promised to alleviate the ethical burden of personal data.