The Hidden Research System: The Evolution of Cytogenetic Testing in the National Health Service

摘要

There is growing public interest in the activities of medico-scientific communities in the provision of healthcare. This is particularly evident in the UK where a number of recent incidents have opened debates including: the use of organs in research following the hoarding of body parts by a pathologist at the Alder Hey Hospital (Jackson, 2001); the clinical validity of research following the politicization of the Measles, Mumps and Rubella triple vaccination (Dyer, 2004a); and the oversight of laboratory procedures after mixed race twins were born to a Caucasian couple following IVF treatment (Dyer, 2004b). As a result the public increasingly want to know how these communities operate and interact. Here we explore the important role such medico-scientific communities play in the shaping of a medical technology, through a case study of cytogenetics. We follow events from the birth of genetics in the early years of the twentieth century to the clinical debut of cytogenetics at the end of the 1950s and its subsequent rise to routine use in prenatal screening from the 1970s onwards. In this context we ask: which groups play a role in innovation? How do their views and context influence the nature and course of innovation? In what ways do such patterns of innovation differ from the forms we are more familiar with, such as the more visible commercial sector (i.e. the providers of highly marketed and regulated drugs and devices)?