The Politics of Personalised Medicine

Hedgecoe, A ( 2004 ) The Politics of Personalised Medicine: Pharmacogenetics in the Clinic . Cambridge : Cambridge University Press , ISBN: 0521602653 £19.99 (pbk) ISBN: 0521841771 €45.00 (hbk) 208pp Pharmacogenetics (PGx) is the study of the genetic basis of drug response and the use of genetic testing to prescribe and develop drugs. It formed the centrepiece of the 2003 Genetics White Paper and has been hailed as a revolutionary medical technology, which will lead to the development of so-called ‘personalised medicine’ and solve a number of important clinical problems. In The Politics of Personalised Medicine Adam Hedgecoe presents a timely and detailed sociological critique of this emerging field. Conceptually, the book is significant in applying ideas from the new field of the sociology of socio-technical expectations, highlighting the way in which supporters of new technologies build expectations in order to mobilise social, economic and technical resources for innovation. In particular, it asks how actors use the ‘future’ to shape the present? Hedgecoe argues that expectations should be taken seriously, rather than being simply dismissed as ‘hype’, and scholars need to engage with scientists’ and industry's visions of the future in order to provide a more powerful analysis of the ethical, social and legal issues (ELSIs) raised by the new genetics. The book is based on two empirical case studies of personalised medicine, APOE4/Tacrine and Her2/Herceptin, as they make their way from the laboratory to the clinic. Both medicines are being held up as the key exemplars of PGx technology and through a detailed analysis of the history, development and contemporary use of these drugs and tests, Hedgecoe draws out three central themes: First, there is a striking contrast between the expectations of the supporters of pharmacogenetics and the experiences and beliefs of professionals at the clinical ‘coal face’ who have to put this technology into practice. While such contrasts are to be expected, they do raise questions about who policy makers should listen to when they want to make investment and health service development decisions. Secondly, there is an important difference between knowledge and resistance. The idea promoted by advocates of the technology is that scepticism stems from a lack of knowledge. However, clinicians are very knowledgeable about the specific drugs they use; yet despite this, they remain doubtful and uncertain, and have a number of important ethical reservations about using pharmacogenetics. The third theme is the contrast between what are portrayed as ‘revolutionary’ technologies (how pharmacogenetics appears in the pages of a review article where it's ‘going to change the future of healthcare’) and ‘ordinary’ technologies (how pharmacogenetics is portrayed when it enters the clinic, and has to fit in with current practice, other technologies and a specific clinical context). Hedgecoe successfully pulls the three themes together showing how in both case studies there are considerable differences in opinion and knowledge of the technology, how clinicians’ resistance and scepticism is rooted in practice, and how pharmacogenetics needs to be seen as bringing about incremental rather than revolutionary change. In conclusion, the author suggests that by analysing the developments of pharmacogenetics in terms of expectations, it becomes more possible for sociologists and others interested in this area to contribute to its development and regulation. This is a valuable book, as it provides one of the few detailed case studies of the translation of an emerging genetic technology into clinical practice. It is conceptually innovative and empirically grounded, and points to a new way of looking at the process of technical change in medicine

Bioethics · Bioinformatics · Business · Engineering ethics · Field (mathematics · Order (exchange · Personalized medicine · Pharmacogenetics · Political science · Politics · Precision medicine · Sociology · Vision · Biomedical Ethics and Regulation · Engineering · Historical Medical Research and Treatments · Law · Medicine · Science, Research, and Medicine