Building Genetic Medicine: Breast Cancer, Technology, and the Comparative Politics of Health Care (review)

Building Genetic Medicine offers a persuasive comparative study about the importance of national context in studies of emerging technologies. Focusing on recent innovations in genetic testing, Shobita Parthasarathy compares United States and British responses to breast cancer gene (BRCA) testing within the framework of cancer studies, globalization, policy, practice, and most significantly transnational technology transfers and applications. The “toolkit” she provides offers an innovative way to consider why and how BRCA testing has been adopted and contested in various times and places.

Parthasarathy’s introduction places her work within a broader context of science and technology studies that examine how culture, networks, actors/users, and others influence technological design and practice. Her comparative study suggests that national context needs amore central place in any such discussions. Her subsequent five chapters map out a toolkit approach to technology studies that allows for critical review of emerging breast cancer technologies.

Genetic medicine evolved differently in the United States and Great Britain during the second half of the twentieth century. While genetic screening was framed by the commercialization of biomedicine in the United States, responses in Great Britain centered on its impact for citizens, especially in terms of its preventative capabilities and cost-saving potential. Comparing the developmental paths in both countries allowed Parthasarathy to consider the different environments of genetics in each country. Moreover, comparisons of the architectures of the laboratory, clinic, users, and decision-makers demonstrated that approaches to genetic medicine were steeped in larger notions of health-care practices. In chapter 2, Parthasarathy delineates the role of medical authorities who facilitated private medical care in the United States, and the adoption of BRCA testing under the National Health Service in Britain. Both countries responded to the emerging technology with great enthusiasm, support from patient activists, and broad ideas about its potential use and application. Yet within different national contexts, each country turned to a technological architecture rooted within its health-care system. This story is further complicated by the shifts evident in each country. As one example, the U.S. story offers a case study of a capitalist business venture, whereby one profitable company eliminates competition and comes to dominate the market.

By the mid-1990s, Myriad, a U.S.-based company, controlled the private market and claimed ownership of the intellectual property of its BRCA testing technique. The National Health Service, comparatively, worked to establish national guidelines in Great Britain and cooperated with established networks to introduce this technology.

The outcome of these dominant systems, examined in chapter 4, offers compelling narratives about why and how categories of breast cancer risk emerged. As one example, Myriad created novel risk categories that advocated a range of responses including increased surveillance, prophylactic surgery, and chemoprevention. In Great Britain, different “at risk” designations determined candidates for further genetic testing. In many ways, chapter 5 analyzes the theoretical divide between private and nationalized health care. Once Myriad achieved dominance in the United States, it sought control of the global market. In divisive international disputes about patent rights and intellectual property, Great Britain resisted Myriad’s claim to ownership of both an idea and a medical practice.

Building Genetic Medicine is a timely book that speaks to issues of technological development, national context, cultural production, and the myriad of influential actors in this process. Its comparative framework offers a glimpse of why and how emerging systems vary. Parthasarathy’s lens demonstrates significant ideological divides in genetic medicine in the United States and Great Britain, while also raising provocative questions about alternative comparative structures. How might two nations with private health-care practices compare? Likewise, how would several nationalized health systems compare? Her book provides a convincing demonstration that comparative case studies broaden our lens of analysis. It also emphasizes the interconnectedness of national context, public policy, political debate, and medical practice. As global medicine and technology transfers assume a more prominent position in daily health-policy decisions...