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Updated 8:30 AM April 16, 2007




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Varied genetic tests for breast cancer detailed in public policy lecture

The United States and Britain have taken profoundly different approaches in developing genetic testing for breast cancer, which has serious implications for users of health care, says a U-M professor.

Shobita Parthasarathy, an assistant professor at the 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 BRCA (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 BRCA testing was initially offered by a number of providers, one company eventually became the sole provider of a test available on demand to consumers.

Parthasarathy discusses today (April 16) her new book, "Building Genetic Medicine: Breast Cancer, Technology and the Comparative Politics of Health Care." The 4 p.m. lecture is at Annenberg Auditorium, 1120 Weill Hall.

Parthasarathy argues that differences in BRCA testing between the two countries have 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 BRCA testing," Parthasarathy, co-director of the Science, Technology and Public Policy Program at the Ford School, writes, "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 1 in 8 U.S. women and 1 in 12 U.K. women will develop 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 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.

Some of the book's key conclusions are:

• 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 BRCA 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 toward 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 public concern.

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