‘Me’ Medicine and Genetic Testing: Abstract

Retail genetic testing, direct-to-consumer over the internet, is just one facet of “me” medicine—personalized diagnostics and therapeutics. Commercial profit-making ventures like direct-to-consumer genetic testing or private umbilical cord blood banks play up the uniqueness of your individual genome or your baby’s cord blood. Pharmacogenetics grandly promises custom-tailored cures for individual patients, while enhancement technologies like deep brain stimulation—‘Botox for the brain’—promote the idea that I have a duty to be the best ‘me’ possible. Because these forms of ‘retail therapy’ push all the right buttons in our psyches—the ones marked autonomy, individualism and choice—they pack a powerful punch. The genetic mystique, the legally doubtful view that we own our bodies and the widening reach of the market in our lives—all produce the idea that ‘me’ medicine is the only game in town. But like the drunk looking for his keys not where he lost them but under the streetlight—“because the light’s better there”—biomedicine is in danger of only concentrating where the halogen glare is brightest: not necessarily on the most effective health interventions, but on the most personalized and profitable.

Credit for the greatest advances in longevity and quality of health over the last two centuries should go to “we” medicine, not “me” medicine. Public health and sanitation programmes, polio and smallpox vaccination, and tuberculosis screening in schools and workplaces have contributed the most to our improved health in the Western world. But when budget cuts threaten those programmes, when parents are put off by scares linkingMMRvaccine to autism, or when media pundits scoff at public health measures to prevent swine flu spreading as overreaction, programmes like vaccination, epidemic prevention and screening are increasingly distrusted.

In India, a campaign has arisen against what might seem like a model public health campaign, vaccination of young girls against the human papillomavirus implicated in cervical cancer. (Sarojini et al. 2011; Sengupta et al. 2011) In Muslim areas of northern Nigeria, which accounts for about 45% of polio cases worldwide, a World Health Organization polio vaccination campaign was boycotted as a Western plot to spread HIV and AIDS through adulterated injections. (Jegede 2007)

Starting from the example of DTC genetic testing but locating it in the broader context of the global reaction against public health programmes and the neo-liberal turn in politics, I will ask two questions: Should progressives promote “we” over “me” medicine? If so, how?

For a background document to this presentation, please see my: "Personalized genetic testing and Me Medicine" (draft, not for quotation) under "Documents Related to This Session" below.

References

Jegede, Ayodele Samuel. 2007. “What led to the public boycott of the Nigerian vaccination campaign?” PloS Medicine 4: e73, doi:10.1371/journal/pmed.0040073.

Sarojini, NB, Anjali Shenoi, S. Srinivasan and Amar Jesani. 2011. “Undeniable violations and unidentifiable violators.” Economic and Political Weekly 46: 17-19.

Sengupta, Amit, Anjali Shenoi, NB Sarojini and Y Madhavi. 2011. “Human papillomavirus trials in India.” Lancet 377: 719.