Frameworks of Choice: Predictive and Genetic Testing in Asia ed. by Margaret Sleeboom-Faulkner (review)

Predicting the future of an unborn child—its sex, its health, its defects—is hardly a purely technical intervention. Matter-of-fact technologies of predictive genetic testing (PGT) may narrow down the individual or culturally specific speculation about the future. Yet they cannot completely extinguish the complexities of culture. Neither may scientific facts, relying on the role of innovative scientists themselves, replace the political decision-making processes on various societal levels. PGT is changing occupational practices, patient behavior, and relations broadly in health care. It is also changing how laymen, as well as experts, think about their future lives and about those of their family members, or about fellow citizens affected by policies one has to take responsibility for.

This edited volume illustrates methodologies of STS in Asia from several vantage points in regard to decision making: how various interest groups and less influential individuals in society estimate and react to the prognosticated future. The great strength of it is ethnographic fieldwork—in Japan, in Sri Lanka, in India, and in China—and that its authors take the numerous questions, long debated according to Euro-North-American-centric paradigms, to Asia. Expectations of new ethnographic findings from Asia might lead curious readers to first ideas of a book rather different from this volume under its title Frameworks of Choice: Predictive and Genetic Testing in Asia. The collection of articles edited by the social scientist Margaret Sleeboom-Faulkner takes up broad (yet Eurocentric) debates about the ethics of health care and science and discusses specific applications of genetics: tests estimating the probability of severe future illnesses such as sickle-cell anemia or cancer, or prognosticating facts that are less clearly identifiable as positive or negative, such as a disability or just the sex of one’s future child.

The book is based on a series of research grants employing and bringing together contributors via conferences and networks during a decade of Sleeboom-Faulkner’s career at the International Institute for Asian Studies in the Netherlands. In Asia, it examines general challenges of applied science: in conversation (i.e., based on interviews) with the scientists and the patients there, introducing also the providers of treatments and collectors of data, and sketching economies of pharmaceutical industries and insurance. Instead of so-called non-Western, traditional, or even exotic cultural practices, the authors examine universally applicable instruments of genetic testing that produce results about any human being, no matter what they believe or how they are feeling. Instead of essentialist features of the separate nation-states, this volume examines particularities based on the roles of different actors in health care. In the context of decision-making processes about PGT testing and the related treatments in the four Asian countries, the authors of eleven chapters introduce those rather different involved actors respectively. Due to the spectrum of topics, the contributors are a rather diverse group. For example, Gerard Porter in his chapter entitled “Genetic Tests and Insurance in Japan: The Case for a Regulatory Framework” discusses the role of health insurance in Japan, that is, claims for coverage within the framework of compulsory national insurance and still-deficient regulations (145–66). Ole Döring’s chapter focuses on families in China coping with the ominous results of PGT (183–200). Helen Wallace’s chapter argues that promised dietary applications are taken into question as overly commerce-oriented (201–10). Sites of discrimination in the four countries demonstrate the problem of sex selection. The index covers sixteen pages and provides a useful overview of key terms, of specific diseases and social groups that are discussed as cases, and of the focus shared by all the authors of very heterogeneous disciplinary backgrounds.

As the authors show, the “ramifications” limiting choices reveal common “themes.” Readers can trace them across the chapters and thus across national demarcations and the prevalent negative images of the three developing countries and the...