Shobita Parthasarathy, an assistant professor at the U-M Gerald R. Ford School of Public Policy, says differences in the American and British approaches to health care and commercialization of research led to the establishment of different genetic testing for breast cancer services in the two countries.
In Britain, the technology is available through the National Health Service as an integrated program of counseling and laboratory analysis, and is viewed as a potentially cost-effective form of preventive care. In the United States, although this testing was initially offered by several providers, one company eventually became the sole provider of a test available to consumers on demand.
Parthasarathy argues that these differences in genetic testing for breast cancer between the two countries has had important implications for the rights, roles and responsibilities of the users of health care, shaped our understandings of risk and disease, and influenced our choices of treatment methods to deal with hereditary risk for breast cancer.
"As we peer inside" genetic testing for breast cancer, said Parthasarathy, co-director of the Science, Technology and Public Policy Program at the Ford School, "we shall learn that it is not simply the presence or absence of a technology that modulates the creation and definition of risk and disease, but also its specific technological architecture, or patterns of technology and regulation."
Current research indicates that one in eight U.S. women and one in 12 U.K. women will contract breast cancer. Those numbers have risen sharply over the last four decades, prompting public demand in both countries for genetic testing to determine hereditary risks for the disease. Parthasarathy, in a new book, investigates the utility of this test, and explores how technologies such as these might best be built to maximize their health benefits while minimizing ethical and social complications.
Her book, "Building Genetic Medicine: Breast Cancer, Technology and the Comparative Politics of Health Care," has some key conclusions:
? The controversial notion of patients as "pre-symptomatically ill" based on the outcomes of genetic testing is linked mainly to the way testing systems are built rather than to the content of genetic science or popular excitement about potential implications and applications of genetic research.
? Technologies should be understood as inextricably linked to specific social and political systems, which can make transnational technology transfer quite difficult. When the dominant firm in the U.S. market for such testing, Myriad Genetics, attempted to enter the U.K. market, it failed and was forced under protest to withdraw. The company did not anticipate the antagonism towards the commercialization of scientific research and the strong support for the provision of "equal access" to health care through the National Health Service.
? Parthasarathy argues that by understanding how the implications of a technology are built into its very design and incorporating this knowledge into the developmental process, we can maximize social benefit and minimize public concern.
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