In Building Genetic Medicine, Shobita Parthasarathy shows how, even in an era of globalization, national context is playing an important role in the development and use of genetic technologies. Focusing on the development and deployment of genetic testing for breast and ovarian cancer (known as BRCA testing) in the United States and Britain, Parthasarathy develops a comparative analysis framework in order to investigate how national “toolkits” shape both regulations and the architectures of technologies and uses this framework to assess the implications of new genetic technologies.
Parthasarathy argues that differences in the American and British approaches to health care and commercialization of research led to the establishment of different BRCA services in the two countries. In Britain, the technology was available through the National Health Service as an integrated program of counseling and laboratory analysis, and was viewed as a potentially cost-effective form of preventive care. In the United States, although BRCA testing was initially offered by a number of providers, one company eventually became the sole provider of a test available to consumers on demand.
Parthasarathy draws lessons for the future of genetic medicine from these cross-national differences, and discusses the ways in which comparative case studies can inform policy-making efforts in science and technology.
About the Author
Shobita Parthasarathy is Associate Professor at the Gerald R. Ford School of Public Policy at the University of Michigan.
“Building Genetic Medicine is an enlightening overview of one of the first skirmishes of our genetic century.”—American Scientist
"Parthasarathy's book is a beautifully structured, clearly written Tale of Two Cultures. Testing for genes that confer risk of breast cancer was born of Mendelian genetic science and DNA analysis technologies, parentage revered on both sides of the Atlantic. As that genetic testing developed into clinical services, however, it turned out that the story was not just about who discovered what when, or even who owned which patents, but also about how decisions are made about health care technologies, health services, and public health. This story is thus a nonfiction Bildungsroman about a genetic innovation that developed quite differently in the United States and the United Kingdom, two cultures divided by a common science."
Robert Cook-Deegan, Director, Center for Genome Ethics, Law, and Policy, Duke University
"The assumption that universally valid generalizations regarding the value of new medical technologies are possible, given good enough clinical evidence, is proving highly resistant to critique from the social sciences. Shobita Parthasarathy shows how and why genetic testing acquired quite different roles in the United States and in Britain, evoking very different responses from patient advocacy groups in the two countries. Her book is not only a valuable addition to the STS literature. I hope that everyone confronting the implications of rapid scientific and technological advance for health care provision will reflect carefully on what it has to say."
Stuart Blume, Chair, The Innovia Foundation for Medicine, Technology & Society, and Professor of Science Dynamics, University of Amsterdam
"Combining historical, comparative, and coevolutionary perspectives, this book offers a highly original and informative account of the emergence of BRCA testing as a much debated and controversial new health care technology. It makes the reader vividly aware of the various ways in which technologies and practices of health care mutually shape each other."
Dirk Stemerding, Science, Technology, Health & Policy Studies, University of Twente, The Netherlands