The rhetoric of geneticization: Science, ideology, and the case of breast cancer.

摘要

This project examines the phenomenon known as "geneticization," which I define as the increasing reliance on the notion of heredity to explain disease to the exclusion of environmental explanations. With breast cancer research as a representative case study of geneticization, I argue that while breast cancer genomics research is progressing/expanding, the idea that the environment is to blame for much of breast cancer incidence is summarily dismissed by the biomedical community and by non-governmental organizations such as the American Cancer Society who wield considerable influence on public debate about such matters. Thus, potentially powerful interventions are left virtually unexplored while biomedicine pursues genetic interventions that will very likely take several decades to come to fruition, if at all. I argue, drawing largely from leftist critiques of science, that this tension, and ultimate trade-off, between the genomics model of disease and the environmental health model, is the result of the competing political perspectives they both represent and help articulate, if only indirectly. If one assumes, as I do, that disease is a marker of social relations, as well as a marker of biological malfunction, disease prevention can take the form of post hoc medical intervention and/or social policy that transforms the conditions of peoples' lives. That genomics privileges the former over the latter indicates its investment in existing social arrangements. I further argue that certain historically-specific rhetorical conditions enable genomics to become a hegemonic ideology. First, debate about genomics fails to critically entertain the possibility of alternatives to contemporary genomics. Instead, stakeholders largely accept and uncritically reproduce positivist images of genetics and discuss this science as the objective, logical outcome of biological research. Second, representations of environmental health science and of the activists organizing around such science, effectively prevent the emergence of a more balanced discourse about gene-environment interaction in explaining disease. Finally, expert discourse, including some rhetoric of science scholarship, privileges apolitical and scientistic intervention, and thus fails to serve the public interest. The alternative, I argue, is expertise that is explicitly political, takes sides, and reconceives expertise in order to serve the goals of empowerment and social justice.