Taking Political Determinants of Planetary Health Seriously: Expanding from P4 to P5 Medicine

Romania's Pioneering Law: Establishing the Right to Personalized Medicine

This analysis and commentary discuss Romania's landmark law, the first globally, acknowledging the right of citizens and patients to personalized medicine. Initiated following the EU Council's 2015 policy on personalized medicine, the law is a result of intersectoral collaborative efforts led by the Centre for Innovation in Medicine in Romania using a quadruple (later evolved to penta) helix model involving academia, public, private, and civil society sectors. Promulgated on May 24, 2023, the law legally entitles patients to personalized health care and in ways informed by individual genetic and phenotypic consideration. The law mandates informed consent for medical interventions and ensures data protection in accordance with the General Data Protection Regulation. We suggest that this pioneering legislation paves the way for integrating personalized medicine into Romania's health care system, shaping clinical practice, research, and health policy. In all, it marks a significant step in redefining health care delivery, emphasizing individualized treatment and the political determinants of personalized medicine, and setting a precedent for future health care innovations worldwide.

Global Governance for Personalized Medicine, Politics of Uncertainty, and Pierre Bourdieu

How we choose to respond to uncertainty matters for robust and responsible science. New laws and consensus reports are popular instruments for global governance of emerging technology and attendant uncertainty. However, the sociologist Pierre Bourdieu noted that "[t]he judicial situation operates like a neutral space that neutralizes the stakes in any conflict through the de-realization and distancing implicit in the conversion of a direct struggle between parties into a dialogue between mediators." Put in other words, while law and legal modes of reasoning are certainly useful for conflict resolution and closure, their overprivileging in emerging technology and uncertainty governance can potentially bring about depoliticization by transforming the struggles and dissent necessary for democratic governance into a "dialogue between mediators." Hence, the critical sociological gaze offered by Bourdieu is particularly relevant for democratization of global governance of multiomics technologies and timely with the current uptake of personalized medicine. For example, in May 2023, the Romanian government introduced a law to give patients the right to personalized medicine. Personalized medicine is related to the larger umbrella concept and field of theranostics, the fusion of therapeutics and diagnostics. It is therefore timely to reflect on a "right for theranostics in planetary health," considering the potential for future pandemics and ecological crises in the 21st century. Rather than forcing consensus or convergence in an innovation ecosystem, dissent grounded in rigorous political theory, sociology of law and critical legal studies can strengthen democratization and global governance for personalized medicine and multiomics technologies.

Technological Encounters in a Knowledge Economy: An Epistemic X-Ray

Climate emergency is a planetary health and systems science challenge because human health, nonhuman animal health, and the health of the planetary ecosystems are coproduced and interdependent. Yet, we live in a time when climate emergency is tackled by platitudes and weak reforms instead of structural and systems changes, and with tools of the very same systems and metanarratives, for example, infinite growth at all costs, that are causing climate change in the first place. Seeking solutions to problems from within the knowledge frames and metanarratives that are causing the problems reproduces the same problems across time and geographies. This article examines and underlines the importance of an epistemological gaze on knowledge economy, an epistemological X-ray, as another solution in the toolbox of decolonial and other social justice struggles in an era of climate emergency. Epistemology questions and excavates the metanarratives embedded in knowledge forms that are popular, dominant, and hegemonic as well as knowledges that are silent, omitted, or erased. In this sense, epistemology does not take the "archives" of data and knowledge for granted but asks questions such as who, when, how, and with what and whose funding the archive was built, and what is included and left out? Epistemological choices made by innovators, funders, and knowledge actors often remain opaque in knowledge economies. Epistemology research is crucial for science and innovations to be responsive to planetary society and climate emergency and mindful of the social, political, neocolonial, and historical contexts of science and technology in the 21st century.