Mitochondrial donation, patient engagement and narratives of hope

This article develops the sociology of hope and patient engagement by exploring how patients' perceptions and actions are shaped by narratives of hope surrounding the clinical introduction of novel reproductive techniques. In 2015, after extensive public debates, the UK became the first country to legalise a mitochondrial donation technique aimed at preventing the transmission of inherited disorders. The article draws on the accounts of twenty-two women of reproductive age who are at risk of having a child with mitochondrial disease and would be the potential target of the technique. We explore the extent to which our participants engaged with the public debates and how they accounted for their support of mitochondrial donation. We show that while the majority of our participants were in favour of legalisation, they did not necessarily wish to use the technique themselves. We found that hope was multi-faceted, involving hope for self, hope for family and hope for society. We conclude by considering the implications of hope narratives for patients and families and the important but potentially limited role that patients can play as advocates for technology.

Somatic individuality in context, a comparative case study

Scholars have challenged the totalizing nature of the "geneticization thesis," arguing that its brushstrokes are too broad to capture the complicated nature of the new genetics. One such challenge has come from Nikolas Rose's argument that genetic medicine is governed by a new biopolitics in which patients understand themselves as "somatic individuals" who treat their bodies as an "ethical substance" to be worked on in order to secure a healthier future. I argue that Rose's argument, while compelling, paints the new genetics in equally broad brushstrokes and that in order for a concept like somatic individuality to become useful, we must study its manifestation across different communities of at-risk individuals. I undertake such a study by analyzing discourse use in two online biosocial communities, showing how the decision-making situations specific to each affect representations of somatic individuality, often creating opportunities for the rhetorical repurposing of older discourses of genetic determinism.

Have we seen the geneticisation of society? Expectations and evidence

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.