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

In Building Genetic Medicine, Shobita Parthasarathy shows how, even in an era of globalization, national context is playing an important role in the development and use of genetic technologies. Focusing on the development and deployment of genetic testing for breast and ovarian cancer (known as BRCA testing) in the United States and Britain, Parthasarathy develops a comparative analysis framework in order to investigate how national "toolkits" shape both regulations and the architectures of technologies and uses this framework to assess the implications of new genetic technologies. BRCA testing was one of the most highly anticipated and publicized technologies of contemporary medicine. Parthasarathy argues that differences in the American and British approaches to health care and commercialization of research led to the establishment of different BRCA services in the two countries. In Britain, the technology was available through the National Health Service as an integrated program of counseling and laboratory analysis, and was viewed as a potentially cost-effective form of preventive care. In the United States, although BRCA testing was initially offered by a number of providers, one company eventually became the sole provider of a test available to consumers on demand. Parthasarathy also reports on an unsuccessful attempt by the American provider of BRCA testing to market its services in Britain. British scientists, health-care providers, and patients rejected the American technology, she argues, because it was part of a social, economic, and political system to which they were not accustomed. Parthasarathy draws lessons for the future of genetic medicine from these cross-national differences, and discusses the ways in which comparative case studies can inform policy-making efforts in science and technology.