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Ann Arbor - The United States and Great Britain have taken
profoundly different approaches in developing genetic testing for breast
cancer which has serious implications for users of health care, says a
University of Michigan professor.
Shobita Parthasarathy, an assistant professor at the U-M Gerald R. Ford
School of Public Policy, says differences in the American and British
approaches to health care and commercialization of research led to the
establishment of different genetic testing for breast cancer services in
the two countries.
In Britain, the technology is available through the National Health Service
as an integrated program of counseling and laboratory analysis, and is
viewed as a potentially cost-effective form of preventive care. In the
United States, although this testing was initially offered by several
providers, one company eventually became the sole provider of a test
available to consumers on demand.
Parthasarathy argues that these differences in genetic testing for breast
cancer between the two countries has had important implications for the
rights, roles and responsibilities of the users of health care, shaped our
understandings of risk and disease, and influenced our choices of treatment
methods to deal with hereditary risk for breast cancer.
"As we peer inside" genetic testing for breast cancer, said Parthasarathy,
co-director of the Science, Technology and Public Policy Program at the
Ford School, "we shall learn that it is not simply the presence or absence
of a technology that modulates the creation and definition of risk and
disease, but also its specific technological architecture, or patterns of
technology and regulation."
Current research indicates that one in eight U.S. women and one in 12 U.K.
women will contract breast cancer. Those numbers have risen sharply over
the last four decades, prompting public demand in both countries for
genetic testing to determine hereditary risks for the disease.
Parthasarathy, in a new book, investigates the utility of this test, and
explores how technologies such as these might best be built to maximize
their health benefits while minimizing ethical and social complications.
Her book, Building Genetic Medicine: Breast Cancer, Technology and the
Comparative Politics of Health Care, has some key conclusions:
- The controversial notion of patients as "pre-symptomatically ill" based
on the outcomes of genetic testing is linked mainly to the way testing
systems are built rather than to the content of genetic science or popular
excitement about potential implications and applications of genetic research.
- Technologies should be understood as inextricably linked to specific
social and political systems, which can make transnational technology
transfer quite difficult. When the dominant firm in the U.S. market for
such testing, Myriad Genetics, attempted to enter the U.K. market, it
failed and was forced under protest to withdraw. The company did not
anticipate the antagonism towards the commercialization of scientific
research and the strong support for the provision of "equal access" to
health care through the National Health Service.
- Parthasarathy argues that by understanding how the implications of a
technology are built into its very design and incorporating this knowledge
into the developmental process, we can maximize social benefit and minimize
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