medical practice away from intervention to risk factor analyses and disease prevention.
The diseases individuals might be predisposed to, how they might react to particular medicines, and what health-promoting behaviors they might take to prevent future illness are all encompassed in this revolution (Rabinow 1996; Eisenburg 1999). Genomic information and the multitude of genomic sequences represent novel targets for therapeutic intervention. In short, the ‘life sciences industry’-- knowledge of the genetic code and how to manipulate it and therapeutic advances -- is transforming public health and biological knowledge. The prospect of widespread genetic testing has prompted concerns about how such information is being used to discriminate against those labeled as having genetic risks in terms of restricting or denying insurance coverage, as is already the case with women who are BRCA1 or BRCA2 positive.
These developments also highlight the depth of demand for “health.” They attest to the power of biomedicine as a rationality in everyday life (in the organization of health care and delivery, legal procedures, policy analysis) that comes up against other forms of knowledge such as religion, and that coexists with older power structures related to family, gender, ethnicity, and class. Health as commodity, to be bought and sold in the marketplace, has led to new freedoms to pursue health but also raises dilemmas and creates new risks: who is caretaker of genomic information? Who will have access to genetic therapies? These questions highlight some of the dangers regarding the social uses of genetic knowledge in the genomic and post-genomic era; they make it difficult to say what counts as success in this drive toward health and profits, a drive which has both sacred and secular sources and consequences.
The trade off between benefits to individuals and risks to populations of any given new technology must also be carefully assessed. Xenotransplantation, which promises to end the so-called shortage in donor organs by engineering transplantable animal organs, offers one prominent example. While such breakthrough technologies may save the life of a few, they pose dangers to populations in terms of the resistant viral strains and antibodies that might develop as a result of such transplant procedures. Another example of the way scientific advancement produces new social risks is found in the case of the traffic in human organs. Such traffic has been afforded by the availability of cyclosporine, among other things. This availability, combined with demand for human organs, has turned vulnerable populations in Brazil, South Africa, and India, into potential organ suppliers. Inconsistencies across the globe regarding the rights of donors as well as the lack of follow-up care for many of them have lead to prolonged suffering or premature deaths, or both. Processes related to the globalization of the life sciences industry demand ethnographic attention to technical advances in terms of their development and diffusion; patterns of accessibility and differences of improved health outcomes between the poor and the non-poor; and new forms of health and vulnerability these advances engender.