Health Promotion International, Vol. 18, No. 1, 79-80,
March 2003
© Oxford University Press 2003
RESOURCE REVIEW |
The New Genetics and the Public’s Health
Alan Petersen and Robin Bunton Routledge, London, April 2002
Doctoral student, Genomics Policy Unit, University of Glamorgan, Wales I welcomed the opportunity to review this book, which claims to be unique in its approach to the issue of genetics and its impact on the public health. Rather than focusing on medical genetics, preventative medicine or bioethics, the book takes a sociocultural approach. The authors set out to address the implications of the new genetics for public health practice and development by tackling five themes: risk and decision-making; the nature/culture dichotomy; anticipated new gene therapies; the role of the media in framing the debate; and the logic of the market. They attempt to examine the ways in which conceptions of health, disease and normality have been reshaped by politico-economic and global issues. These issues are examined by looking at the cultural context in which public health genetics is placed. This is then related to the impact this has upon the individual or ‘self’. Although there is an attempt to link the chapters, in reality they can be considered as a series of independent essays.
Petersen, who has written the lion’s share of the book, introduces the ‘new genetics’ by saying it is a contested term that is widely used but poorly defined. He presents a range of definitions for the new genetics that he finds unacceptable. His main concern is that authors outline specific aims or outcomes of the genetic technologies rather than presenting a definition. Petersen offers his own interpretation, arguing that there is very little to distinguish the ‘new genetics’ from the ‘old eugenics’ because, in the most general terms, both are concerned with ‘human betterment’. Eugenics, he argues, was supported by the state’s desire to improve the population, whereas the ‘new genetics’ is, as both a term and a concept, possible because we live in a society that encourages neo-liberalism, i.e. a society managed through the political and cultural contract between government, people (the electorate) and their subsequent actions. For example, in developed countries the government acknowledges that it is much easier to achieve predetermined goals if people believe that they are autonomous and have ‘freedom of choice’. So utilizing one of the key aspects of neo-liberalism, ‘active citizenship’, people are encouraged to manage their own affairs through adopting risk minimizing strategies, such as screening. Based upon neo-liberal principles, advances in genetic technologies have encouraged society to frame the individual as an ‘active seeker’ of information through the use of terms such as ‘freedom of choice’ and ‘autonomy’. Emphasis is placed on the importance of achieving genetic literacy so that the individual can minimize their ‘risk’ of developing disease. This, Petersen argues, has informed discussions about the new genetics and its benefits, diverting attention away from the global and social issues that affect health, and placing the responsibility of ill health with the individual and family members.
Foucault’s work on bio-power is used to interpret the impact of the new genetics upon the public’s health. Bio-power, in its simplest form, is about the level of control that it is possible to achieve over life processes. The Human Genome Project (HGP) symbolizes the discourse and practices of bio-power because by revealing what happens at molecular level in the body, it then becomes possible to control conception, birth, morbidity and mortality. Petersen has selected to offer a rather optimistic perspective on the possible benefits of the HGP. There are numerous authors who are cautious about suggesting that knowledge of the genome can be of direct therapeutic value to the general population. However, Petersen documents his concern that genetic knowledge will have a negative effect upon the public’s perception of the body. Terms such as ‘genetic abnormality’ or ‘genetic defect’ he believes convey a vision of a ‘broken body-machine, which needs to be corrected or fixed’.
Bunton, in his chapter on gene technology and public health, documents his concerns about how genetics is altering the way in which public health is viewed, and also relates this back to ‘the body’. He explores in great detail the origins of public health before offering one that he finds acceptable. The definition offered concerns the individual, the environment and agent, and the services that have been used to maximize health such as behavioural, social and preventative measures (p. 77). Advances in genetic technologies will alter the relationship that currently exists between the individual and external factors. Greater understanding of the genetic basis of disease has altered the perception of the body so that it is now perceived as a ‘plastic body, open to change, developments and improvement’. The potential ability to manipulate genes in order to ‘improve’ or change the body leads Bunton to conclude that there will be less opportunity for social and environmental factors to impact upon health. With some sadness, he suggests that genetics has altered the traditional view of the individual as a stable ‘biological’ force.
Petersen aims to ‘expose and critically appraise the assumptions that underpin genetic counseling’ in his chapter on facilitating autonomy. He refers to the works of Clarke, Marteau and Chadwick, practitioners with extensive publications in genetic counselling, to elucidate his main points. Apart from making some generalizations, such as ‘genetic counseling is underpinned by the belief that health is a commodity that can be purchased’ and that counselling is performed without an attempt to understand an individual’s ‘background, perception of risk or ways of reasoning’, Petersen’s critical contribution questions the neutrality of counselling per se, and genetic counselling specifically. This is an interesting chapter, and offers a comprehensive literature review reflecting the current concerns about the speciality of genetic counselling, and he questions whether counsellors can remain objective, non-directive and value free, given the increased pressure on resources and the consequent choices on provision that will have to be made.
The New Genetics and the Public’s Health offers a thought provoking analysis of some of the cultural issues associated with genetics, and the impact that this has or may have upon the public’s perception of themselves and their health. The authors highlight that these advances do not occur in isolation, and that inevitably society and the way that we think about ourselves, health and illness will be changed by such technology. It would have been interesting for the authors to consider how this may impact upon the delivery of health care or how the practice of health promotion might change.
One of the unfortunate aspects of the book is that there is no clear indication of at whom the book is aimed. It is essentially a sociological text aimed at other medical sociologists, and to this extent served a purpose. It was very interesting to read about what the sociocultural perspective could offer to my understanding of genetics, and I was encouraged to reflect upon whether genetics had changed my perception of the body and health. Many of the points made are relevant to any practitioner with an interest in genetics; the book will hopefully encourage debate. However, some of the language used within the book made it inaccessible at times, preventing the reader from fully engaging with the issues raised. One of the authors’ stated aims is to explore whether the benefits of the new genetics outweigh the disadvantages. A well balanced argument is not offered. Rather, there is a tendency to present an over critical and perhaps negative view of the ‘new’ genetics and its impact on public health. The reader is left with the overwhelming feeling that gaining an understanding of the genetic basis of disease will bring no net benefit to individuals or society.
In summary, the authors provide a persuasive, theoretical, interesting and valid argument that encourages the reader to question the way in which the genetic technologies have been presented and are currently perceived. However, the arguments are often framed in such a way that it does take time to digest and make sense of the information presented. I would suggest that it is a book to dip into rather than to read from cover to cover, and that it is read in conjunction with a text that offers a broader overview of the advances associated with the new genetics.
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