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Medicine, Healthcare and Philosophy 1: 235243, 1998.

1998 Kluwer Academic Publishers. Printed in the Netherlands.

Geneticization, medicalisation and polemics

Adam Hedgecoe
Department of Science and Technology Studies, University College London, Gower Street, London WC1E 6BT, UK
(E-mail: urchamh@ucl.ac.uk)

Introduction A divisive differentiation between individuals on


genetic grounds.
Geneticization is the word used by the Canadian soci- Two levels of effect; the conceptual and the beha-
ologist Abby Lippman to describe a process in which vioural (how we look at people and how we treat
differences between individuals are reduced to their them).
DNA codes (Lippman, 1992, p. 1470). As a term, Rather modest requirements for the extent to
it has been used by several philosophers commenting which genetics is actually thought of as determ-
on the role and implications of genetics in medicine ining a disease or disorder rather than just being
(e.g. Hoedemaekers and ten Have, 1997; Koch, 1993; involved in it in some way.
Edlin, 1987). It is often suggested by these authors The extension of genetics into health via the use of
that increased knowledge of the human genome will technology.2
lead to genetic explanations of disease, health and Geneticization is an inherently social process, and
behaviour becoming the norm in a wide range of as such affects and can be affected in turn by the
social and medical settings. Like other terms such as social/cultural context within which it takes place,
Nelkin and Lindees Genetic Essentialism (Nelkin redefining what is taken as social or cultural, and
and Lindee, 1995) it has also been adopted by oth- what is taken as natural. The same technologies
ers (e.g. Hubbard and Wald, 1992). Yet it is not and attitudes in a different society could have very
actually clear that the ideas put forward by Lippman, different results.
Nelkin and others are based on convincing empirical One criticism of the term geneticization is that it is an
evidence rather than theory-derived polemic. Because overly general description that obscures the fact that
these claims are widely cited in both scientific and contemporary genetics discourse is a permutation of
philosophical/bioethics literature, it is important that long-standing hereditarian discourses that reflect age-
they are subjected to close scrutiny. This paper will old recognitions by human beings that heredity plays a
define and present the concept of geneticization and role in the characteristics of living things (Condit and
related terms, show how there are historical preced- Williams, 1997, p. 220). Condit and Williams suggest
ents to its type of reasoning and outline the evidence instead, that such a process should be seen in terms
against such a position. Finally, I wish to suggest some of the medicalized version of hereditarian discourse
future approaches for commentators on genetics and (p. 221), but it is not immediately clear what advant-
medicine, derived from these considerations. ages such a rephrasing would have. Lippmans papers
are certainly focused on medical topics3 and the fact
that she does not set her case studies in a broader
What is geneticization? historical context should not be seen as failure. Rather,
as I shall argue in the final section of this paper, such a
The definition of geneticization presented in this paper small scale approach focusing on particular technolo-
is distilled out of three Lippman papers: Prenatal gies or conditions, avoiding sweeping generalisations
Genetic testing and Screening: Constructing Needs about historical movements, is the only productive way
and Reinforcing Inequalities (1991), Led (astray) by to approach such a confused, complex topic such as
Genetic Maps: the Cartography of the Human Genome this. To some extent, Lippman is examining a small
and Health care (1992), and The Genetic Construction section of what has been called the molecularisation
of Prenatal Testing: Choice, Consent or Conformity of medicine (Feldman and Tauber, 1997) and it is this
for Women? (1994). From these papers, it is clear that approach (i.e. the application of genetics to medicine)
for Lippman, a comprehensive definition of geneticiz- rather than the reverse (the medicalisation of already
ation would have the following characteristics1 : present hereditarian discourses) that will be the focus
236 A DAM H EDGECOE

here. This is not to deny Condit and Williams point use them as roughly interchangeable concepts, since
that discussion of genetics and biological inheritance they are both used by commentators on genetics and
did not arrive in the public domain with the advent of health care in similar ways and both make similar
molecular biology, but it is to highlight, that for some points.
commentators and critics at least, the current devel- The question to be asked now is whether these
opments in the new genetics, and their relationship ideas are actually that influential, and thus in need of
with medicine and society are both qualitatively and this analysis. The BIDS database lists 50 citations for
(possibly) quantitatively different from what has gone Nelkin and Lindee since 1995.4 Lippmans 1991 art-
before. icle alone has 64 citations5 and since 1990, she has
Linked to geneticization are the ideas of Nelkin and been cited 167 times. While such information does not
Lindee in their 1995 book The DNA Mystique: the gene prove that these ideas are widely used, both by social
as a cultural icon, in which they analyse the impact scientists and philosophers, it does suggest that Lipp-
of modern genetics on popular culture, and propose a man and Nelkin are articulating a widespread belief in
dominant view of genetics in society which they call the status and the role of genetic information in society
Genetic Essentialism. Genetic Essentialism proposes and medicine.
the gene as a secular, scientific version of the human
soul: DNA has assumed a cultural meaning similar to
that of the Biblical soul. It has become a sacred entity, Medicalisation
a way to explore fundamental questions about human
life, to define the essence of human existence, and In the 1970s, a number of commentators grew increas-
to imagine immortality. (Nelkin and Lindee, 1995, ingly concerned about the increasing role of medicine
p. 40). The gene that is the centre of genetic essen- in society, a process that became known as medical-
tialism, is no longer a biological entity . . . its symbolic isation. Writers such as Ivan Illich and Irving Kenneth
meaning is independent of biological definitions. The Zola suggested that more and more, medicine was
gene is, rather, a symbol, a metaphor, a convenient becoming an institution of social control, nudging
way to define personhood, identity and relationships in aside . . . the more traditional institutions of religion
socially meaningful ways. The gene is used, of course, and law . . . becoming a new repository of truth (Zola,
to explain health and disease. But it is also a way to 1972, p. 487). Such claims are very similar to those
talk about guilt and responsibility, power and priv- made by Abby Lippman and other critics of genetics
ilege, intellectual or emotional status (p. 16). It is clear (such as Nelkin and Lindee) about geneticization, and
that this definition makes genetic essentialism broader it would seem likely that her ideas are based to some
than geneticization, yet there are striking similarities. extent on the work of these earlier writers.6 The aim
Nelkin and Lindees concept is less well defined than of this section of my paper is to examine medicalisa-
Lippmans but as its main components, one could say tion as a precursor to geneticization, and to suggest
that it would involve: similarities and differences which may assist in ana-
lysis of the latter concept. As one might expect, a
A strong form of genetic determinism, where
broad term like medicalisation covers a variety of pos-
DNA is granted extraordinary powers of agency
itions, from the extreme The medical establishment
and control over human behaviour (Nelkin and
has become a major threat to health (Illich, 1990,
Lindee, 1995, p. 196).
p. 11)7 to milder viewpoints, like those of Rene
Genetic reductionism, again of a fairly extensive
Fox, who although wary of the extremes that medi-
kind (DNA as the secular equivalent to the soul).
cine can lead to, are also conscious of the positive
[E]mphasis on the natural origins of human dif-
role that it has played. In what follows, I intend to
ference (p. 197), putting marginal social groups
present the extremist case of medicalisation in its
at risk of exclusion.
fullest form, the criticisms that have been made of
The stress on reproductive control and technolo-
such a stance, and the possible lessons that can be
gies.
learnt for the analysis of the more recent process of
While these ideas are far broader then Lippmans, geneticization.
there are similar, complementary, themes running EMT: The extreme Medicalisation thesis (EMT)
through them. The role of genetic differentiation is I intend to examine is derived from the writings of
again highlighted, as is the importance particular both Illich and Zola. The central theme is that modern
technologies have in strengthening genetic essential- western medicine has done little to improve and indeed
ism/geneticization. It is obviously more deterministic has often actually been detrimental to, the health of
than geneticization, as well as being more reductive. populations, and that society has become medicalised,
For the purposes of this paper though, I intend to so that it now thinks of most problems and social diffi-
G ENETICIZATION , MEDICALISATION AND POLEMICS 237

culties in terms of medicine, and solutions in terms of There is an important role for pain, or suffering, in
medical treatments. Illich uses the term iatrogenesis8 cultural iatrogenesis; It [cultural iatrogenesis] sets in
to cover the negative impact of medicine on human when the medical enterprise saps the will of people to
health; specifically, clinical iatrogenesis, social iatro- suffer their reality . . . Professionally organized medi-
genesis and cultural iatrogenesis. cine . . . has thereby undermined the ability of indi-
Clinical Iatrogenesis concerns the effects (or lack viduals to face their reality, to express their own
of them) of specific medical treatments. For example values, and to accept inevitable and often irremediable
The study of the evolution of disease patterns provides pain and impairment, decline and death (Illich, 1990,
evidence that during the last century doctors have p. 133). While Zolas work is less obviously extreme
affected epidemics no more profoundly than did priests than Illichs, he is clearly writing in the same vein,
during earlier times (Illich, 1990, p. 23) and The focusing on the political and normative strengths of
pain, dysfunction, disability, and anguish resulting modern medicine; The socio-political impact of medi-
from technical medical intervention now rival the mor- cine however, goes far beyond the specific activities
bidity due to traffic and industrial accidents and even and opinions of practising physicians. One such area
war-related activities, and make the impact of medi- of encroachment is increasing use of the metaphor of
cine one of the most rapidly spreading epidemics of health and illness as an explanatory variable if not the
our time (Illich, 1990, p. 35). explanation itself of a host of social problems (Zola,
Social Iatrogenesis claims that medical practice 1975, p. 85).
sponsors sickness by reinforcing a morbid society that The most obvious criticism of the EMT is that it
encourages people to become consumers of curative, is too extreme. Illich seems incapable of making a
preventive, industrial and environmental medicine statement without putting it in the most radical frame,
(Illich, 1990, p. 42). The process by which this comes without the use of hyperbole. In 1978, David Horrobin
about is explained by Zola: published a blow-by-blow refutation of Illichs claims
in his book Medical Nemesis: a reply to Ivan Illich.
The gradual change of medicines commitment His first point of attack is obviously this tendency of
from a specific etiologic model of disease to a Illichs to exaggerate: He seems to be implying that
multi-causal one as well as its increasing accept- it is better to die early as the result of a stroke than
ance of such concepts as comprehensive medicine to live a much longer if mildly uncomfortable life
and psychosomatic has enormously expanded that as a result of treatment for hypertension (Horrobin,
which is or can be relevant to the understanding, 1978, p. 11). Illichs extreme claims are only possible
treatment and even prevention of disease. Thus through a very selective reading of the historical facts
it is no longer merely necessary for the patient involved. For example, he claims that the reduction in
to divulge the symptoms of his body but also death from various infectious diseases has nothing at
the symptoms of daily living, his habits and his all to do with medicine or doctors, but depends upon
worries. (Zola, 1977, p. 52) environmental factors such as clean water and sanit-
To a large extent, social iatrogenesis depends on the ation: For more than a century, analysis of disease
particular health provision context a person is a patient trends has shown that the environment is the primary
in; for example, large scale medical bureaucracies determinant of the state of general health of any pop-
which induce stress in the individuals the process can ulation (Illich, 1990, p. 25). Such a claim may be
be said to be socially iatrogenic (Illich, 1990, p. 49), true, but ignoring the role of the medical profession
as can the ever-increasing scale of the health budget in in this state of affairs requires a failure of memory,
most western countries (p. 60). for Many of the important environmental changes,
Cultural Iatrogenesis is the final stage, a separate particularly in the supply of clean water, the safe dis-
level where: posal of excreta and the provision of specific items of
diet such as iron and vitamins, were initiated and put
the so-called health professions have an even into effective use by doctors . . . A lively interest on
deeper, culturally health-denying effect in so far the part of the medical profession was almost always
as they destroy the potential of people to deal important in creating an appropriate atmosphere for
with their human weakness, vulnerability, and advance, even when the initial causes of the improve-
uniqueness in a personal and autonomous way ment proved not to be specifically medical (Horrobin,
. . . It occurs when people accept health manage- 1978, pp. 910). Illichs selective interpretation of
ment designed on the engineering model, when medical history is also evident in his use of the term
they conspire in an attempt to produce, as if it were specific medical treatment which excludes treatments
a commodity, something called better health not given only by doctors. Thus immunisation, vac-
(Illich, 1990, p. 42). cination, anti-malarial drugs and hygiene procedures
238 A DAM H EDGECOE

adopted by midwives are excluded since they do not that homosexuality is no longer classed as an illness
involve medical equipment (Illich, 1990, p. 29). by psychiatrists. By regarding all medicine as a single
Although Illich recognises that these procedures were object of study, Illich and Zola lose any sense of sub-
initially started and developed by doctors, because they tlety in their criticisms, and open themselves up to the
only truly began to reduce mortality by the incorpora- sorts of attack mounted by Horrobin. One example
tion of these procedures and devices into the laymans of the blindness to the nature of the role of medicine
culture (Illich, 1990, p. 29), they do not really count in society is their belief that the current position of
as medical treatment. Horrobin calls this the most medicine in Western societies is unique, but as Fox
special sort of special pleading (p. 10), but it seems points out in all societies, health illness and medi-
to me even more contradictory than that. Here are cine constitute a nexus of great symbolic as well as
procedures that have been developed and used by doc- structural importance (Fox, 1987, p. 472). A great
tors; they gain effectiveness only when they enter the deal of anthropological work has been carried out on
social world, the laymans culture. Yet this is the how other societies relate to medicine and disease, and
most blatant form of medicalisation, the introduction how medicalisation cannot be said to be limited to
and spread of techniques and procedures, from the modern, Western capitalist societies. Indeed, there are
medical profession to the layman. Surely this is what certain respects in which health, illness and medicine
Illich is trying to oppose. In turn, this position con- are imbued with a more diffuse and sacred kind of
flicts with Illichs objections to the use of replacement significance in nonmodern than in modern societies
therapy (i.e. insulin by diabetics) only a few pages (Fox, 1987, p. 472). Others criticise Illich from a his-
later; isnt the use of insulin injections by diabetics the torical position (Kleinman, 1982) or a methodological
incorporation of a procedure and device into laymans one (Janzen, 1982, p. 3). The theme of these objec-
culture? tions combines the claim that medicalization is more
Horrobins list of Illichs inconsistencies and con- complex than has been presented by the exponents of
tradictions last an entire book, and there is certainly the EMT, that empirically their work leaves much to
not enough space to reproduce them here. What I be desired, and as a result, more work, using vary-
do want to suggest is that Illichs work is driven ing methodologies is required. Medicalisation is still a
by polemic rather than empirical data; Although his topic of discussion in the philosophy of medicine (e.g.
volume appears to be well documented, a disturbing Donchin, 1996; Burgess, 1993). I want to suggest that
discrepancy exists between the data presented in many the current state of the debate surrounding geneticiza-
of the works Illich cites in his copious footnotes and tion is open to many of the same criticisms that were
the interpretative liberties that he takes with them levelled against those promoting the medicalisation
(Fox, 1987, p. 465). The most obvious example of this thesis twenty years ago.
interpretative liberty is Illichs claim that the facts
about iatrogenesis are well repressed (p. 23) despite
the fact that he relies for much of his data on leading The weakness of geneticization
science and medical journals such as the BMJ, JAMA,
and the New England Journal of Medicine. Most of This section aims to examine the work of Celeste
the evidence on which Illichs polemic is based has Condit, who in a number of recent papers, has cast
therefore been gathered by doctors concerned about doubt on geneticization and genetic essentialism. In
the problems of their own profession, and anxious to particular, she challenges the claim that the use of
improve the situation by bringing them into the open genetic explanations in public is more common now
. . . It is exceedingly unlikely that any other profession than in the past (or that these explanations are being
(certainly not the law) would be as openly self critical used increasingly), and she questions whether one of
and as careless in the publication of damning evidence the main tenets of the geneticization thesis, that the
(Horrobin, 1978, p. 6). way genetics is described by scientists and the media,
Much of the exaggeration of the EMT comes from has a geneticizing effect on the public perception of
the fact that it talks about a single entity called medi- genetics. Condits research suggests that the critics of
cine and claims that evidence of medicalisation from genetic determinism have consistently over stated their
one area of medicine (for example mental health), must case, for what she suggests are both ideological rea-
be true for all areas of medicine, hence medicalisation sons, and because of poor methodology. In this section,
must be happening in all areas of medicine, impact- I wish to present her claims, evaluate how convincing
ing on all parts of society. As Rene Fox has pointed they are, and draw conclusions that might result from
out Along with progressive medicalization, a process them for future study of this topic.
of demedicalization seems also to be taking place in Non-deterministic Blueprints: In this study (Con-
the society (Fox, 1987, p. 477), one example being dit, 1997), Condit presents evidence which challenges
G ENETICIZATION , MEDICALISATION AND POLEMICS 239

the received wisdom that using the metaphor of blue- gene (Nelkin and Lindee, 1995, p. ix). But while it
print to describe genes is inherently discriminatory is true that Nelkin and Lindee do give examples of
and overly deterministic. She cites concern with this the many contrasting, sometimes contradictory, ways
blueprint in Nelkin and Lindee (pp. 164168),9 in in which genetics is presented in popular culture, they
Lippman (1992, p. 1471)10 and another book critical of do not seem to address the possibility that an audience
genetic determinism, Hubbard and Walds Exploding may interpret something as basic as a blueprint meta-
the Gene Myth (1992).11 Condits study sets out to test phor in anything other than a deterministic way. This
the publics interpretation of the blueprint metaphor. undermines the second theme of the critics objec-
The particular public she chose was 137 undergradu- tions to the metaphor, that the concept of the blueprint
ate students at a southern US university. This choice encourages a deterministic view of genetics in the
was partly pragmatic, but she also justifies it on the public mind. Such claims from Nelkin, Lippman and
grounds that high income, literate persons approach- others seems to be based on an assumption about how
ing child-bearing age can be expected to be both major the public interprets particular metaphors, rather than
users of genetic technologies and major influencers any empirical data.
of public policy, and . . . they are the most frequent Increasing Geneticization over time: Another
users of print media (Condit, 1997, p. 6). The stu- important pillar of the critics attack is that genetic
dents were presented with one of two different news determinism, however it is phrased (geneticization
articles presenting genetics in different lights (either or essentialism) is on the increase. This may be
in terms of a genetic lottery, or blueprint). The linked to the Human Genome Project (for example,
results of this study were varied, with only 39 of the Lippman 1992 starts with an outline of the aims of
137 offering deterministic interpretations of genetics, the HGP and a description of the technologies used,
and 58 responses being explicitly nondeterministic. (p. 1469)) or may be a product of social conditions:
This backs up what Condit describes as a platitude genetic explanations appear to provide a rational,
in communication studies, but which is all too often neutral justification of existing social categories . . . .
forgotten in more popular discussions of media that They are thus a convenient way to address troubling
audiences are active readers, who bring their own social issues: the threats implied by the changing
interpretations and counter interpretations to bear on roles of women, the perceived decline of the family,
messages (p. 8). Nelkin and the other critics first mis- the problems of crime, the changes in the ethnic
take seems to be the assumption that everybody jumps and racial structure of American Society, and the
in the same direction when presented with the same failure of social welfare programmes (Nelkin and
material. Lindee, 1995, p. 194). The point is, that it is getting
The critics second mistake seems to be that the worse. This belief in an increase is clear in Nelkin
public interprets the blueprint metaphor in the same and Lindee: Increasing popular acceptance of genetic
way as they do; audience members saw the blue- explanations . . . (p. 3), the popular appropriation of
print metaphor as relative, open and nondeterministic genetics has intensified . . . (p. 5) As the science of
because they interpreted the blueprint as malleable genetics has moved from the laboratory to mass
rather than fixed (p. 8). The Oxford English Diction- culture, from professional journals to the television
ary defines a blueprint as 2. fig. A (detailed) plan or screen, the gene has been transformed . . . . it has
scheme; a pattern (OED). In the audiences view blue- become the key to human relationships . . . it has
prints are simply outlines and plans (Condit, 1997, become the essence of identity and the source of social
p. 8, Emphasis added) and particular features of brick difference (p. 198, all emphasis added). In an out-
and mortar not only can change a plan, but also can line of their work, Nelkin and Lindee write of the
make a substantive difference in the reality of the cultural preoccupation with bad genes . . . [and that]
finished structure itself (p. 8). It may be that this Contemporary narratives often attribute behavior that
is not the correct (i.e. technical) interpretation of threatens the social contract to bad genes (Nelkin
the blueprint metaphor used by the critics, but cor- and Lindee, 1996, p. 95). In a similar way, Lipp-
rect or not, this is the interpretation of the metaphor mans definitions of geneticization all require that it be
used by a large number of Condits respondents, and seen as a process, i.e. changing and increasing over
the critics position leaves no room for the possibil- time.
ity that that such an interpretation could take place. To test this claim, Condit and her colleagues car-
This is particularly ironic in the case of Nelkin and ried out a review of popular literature, to determine
Lindee, who explicitly state in the preface to their the way in which genetic determinism has been por-
book: We assume . . . an active interaction between trayed in the mass media, and whether this portrayal
text and reader, media and audience. Indeed we stress has changed over time. Her research used the Read-
the diversity of peoples interpretations and uses of the ers Guide to Periodical Literature, to select articles
240 A DAM H EDGECOE

Table 1. Relative degree of determinism in Mass Magazines (Condit et al., 1997, p. 20)

191931 194554 196776 198595

No. of articles opposing genetic influence 7 1 0 0


8.4% 2.1% 0% 0%

No. of articles attributing influence to gene + environment 51 28 41 41


61% 58% 55% 73%

No. of articles attributing influence to gene only 25 19 34 15


30% 40% 45% 27%

from popular magazines from 1919 to 1995 50 art- the largest, most systematic and rigorous sample
icles were chosen from five year blocks (pentades) (p. 6) while there are no consistent national indexes
making up this time period, on the basis of their con- for newspapers that span these time periods [i.e. back
taining words such as heredity, genes, eugenics, to 1919], and indexing of single newspapers varies
defectives and other such terms (Table 1). A coding widely and is relatively recent for most newspapers
system was then developed to measure the degree and (p. 14). Problems with other media (such as recor-
type of genetic determinism featured in the articles, ded news programmes and congressional discourse)
and the articles were coded by three independent paid mean that data collected from these other media are
coders.12 used only to assess the representativeness of mass
magazines for the broader range of public discourse
The general trends in the discourse indicate that,
(p. 14). These alternative sources suggest that news-
over time, contrary to the claims of the critics,
papers are more deterministic than magazines . . . [and
there has not been a significant increase in the
that] . . . Newspapers also do not show the decrease
level of determinism in the public discourse about
in determinism across time of the magazine sample.
heredity and genetics. Indeed, statistical analysis
However, they show similar patterns with regard to
of these data verify that more recent discourse has
type of characteristic attributed to genetic causation
become somewhat less deterministic (Condit et al.,
(p. 14). Thus this raises questions about how influ-
1997, p. 8)
ential different media are, and whether the empirical
Condit also suggests that Change in the type of char- results that hold true for mass magazines can be used
acteristics to which genetic causality has been attrib- to draw conclusions about other media where empir-
uted has been, perhaps surprisingly, also in a more ical evidence is less available. Condit is aware of these
progressive direction . . . there have been statistically difficulties, but concludes that Taken as a whole, this
significant reductions in attribution of genetic causes to systematic study of the character and degree of genetic
mental characteristics . . . Overall, coders thus found a determinism in popular media does not confirm state-
consistent trend in which fewer statements were made ments by critics that contemporary attention to genet-
attributing genetic causation to mental and behavioral ics represents an increasingly biologistic determinism
characteristics (Condit et al., 1997, pp. 1112). In (p. 16). The critics might argue that Condits study can-
addition, across time, magazine articles were making not draw conclusions about popular media as a whole,
more fine distinctions among the relative degrees of only one segment (and perhaps not the most influential
genetic influence on different types of conditions. This one). Condit might reply that even if the other media
would appear to represent an increasing sophistication are more deterministic than mass magazines, other
about the probabilistic character of genetics and the media remain static . . . [while] . . . all media show sim-
partiality of its role (p. 1314). This would also seem ilar patterns with regard to types of features attributed
to offer empirical evidence opposing the critics views, to genetic influence (p. 15).
which could be described as not having systematically A larger problem is that:
characterized the deterministic components of public
discourse about genetics, but instead have relied on A review of the Readers Guide to Periodical Lit-
highly subjective anecdotal impressions (Condit et al., erature from 1976 to 1982 revealed a 231 percent
1997, p. 3). This is not to say that Condit regards increase in articles that attempted to explain the
her approach as foolproof, and there are a number of genetic basis for crime, mental illness, intelli-
aspects to her empirical evidence that require mention. gence, and alcoholism during this brief six-year
Firstly, mass magazines were used because they offer period. Even more remarkably, between 1983 and
G ENETICIZATION , MEDICALISATION AND POLEMICS 241

1988, articles that attributed a genetic basis to play in our culture, and without any attempt to show
crime appeared more than four times as frequently the predominance of such stories, the importance of
as they had during the previous decade (Duster, Nelkin and Lindees analysis is very limited. They
1990, p. 93). claim that they have not compiled quantitative data
and do not think it would have been appropriate and
Dusters study is not outlined in anything like the detail meaningful to do so15 (Nelkin and Lindee, 1995,
of Condits, but it does not seem to fit easily with p. ix); rather than carrying out a statistical study,
her conclusions about the apparent steady levels of they present an analysis of folklore (p. ix). The prob-
determinism in mass magazines. One reply might be lem lies not in their analysis, but in the assumption
that Condits study is far broader, covering a time that the folklore that they are analysing is the predom-
period almost thirteen times that of Dusters (76 years inant one in western culture. This is an assumption
as opposed to only 6 years), and thus any trends that too far, and they fail to offer any evidence for it
crop up in Dusters study may in fact be rather loc- whatsoever.
alised and minor in the longer term view. Although
this is a reasonable point, it is undermined by the
fact that Condits 1997 study is a development of her Conclusions
1995 work, using a similar methodology, but only
looking at a twenty year time scale, from 1971 to The aim of this piece has been to cast doubt on one of
1991. This produced very similar results to her later the starting points for much of the discussion surround-
study; there was no increase in biological essential- ing genetics in medicine and health care. There seem
ism in the public discourse during the period in which to be strong similarities between discussions of medi-
medical genetics . . . began to replace earlier heredit- calisation in the 1970s and the problems of that thesis,
arian [i.e. 19711981]13 discourses . . . In fact, there and the current situation with regard to geneticization.
was virtually no change across time in biologically Current discussion of geneticization involves large,
determinant statements, nor was there an increase in sweeping claims based on macrotheoretical perspec-
the assignment of biological determinism to behavioral tives (Condit and Williams, 1997, p. 221). However
or psychological components (Condit, 1995, pp. 122 attractive and intuitively correct such claims are, they
123). Without more information on the methodology lack adequate grounding in empirical reality. This is
used by Duster, it is hard to say whether the appar- not a call for all philosophers to become sociologists,
ent incompatibility between these two studies is due just a warning that the contribution any philosopher
to error on the part of one of these researchers, dif- makes to this debates is only as good as his/her empir-
ferences in methodology or an underlying problem ical information. The solution lies perhaps in small
with quantitative surveys of textual materials. Con- scale studies, which focus on individual elements
dit herself has stated in personal communication: I of geneticization, such as its role in a single dis-
find the quantitative material on its own to be insuf- order, or the introduction of a specific item of genetic
ficiently informative, but it has certainly opened my technology.
eyes and helped me to deepen my qualitative work in
ways I wouldnt have expected.14 But the benefit of
such quantitative studies, however limited they might Notes
be, is that they highlight the methodological weakness
of work such as that of Nelkin and Lindee. When 1. Geneticization refers to an ongoing process by which dif-
they claim that The idea of genetic predisposition is ferences between individuals are reduced to their DNA
often used to explain a common contradiction (1996, codes, with most disorders, behaviours and physiological
p. 95) there is no attempt to say how often is often. variations defined, at least in part, as genetic in origin. It
Although they describe hundreds of stories in popular refers as well to the process by which interventions employ-
magazines, news articles, talk shows, TV programmes, ing genetic technologies are adopted to manage problems of
novels and childcare books that define the person as a health (1991, p. 19).
DNA readout (1996, p. 95), they fail to show how rep- geneticization [is when] differences between individuals
resentative these stories are. There may be thousands are reduced to their DNA codes, most disorders and beha-
viours as well as physiological variations are defined as at
of alternative stories, defining the person as a result a
least in part genetic in origin and the adoption of interven-
complex interaction of their environment, genes and tions that employ genetic technologies to manage health is
contingent historical events. Or even extreme behavi- advocated (1992, p. 1470).
ourist stories claiming that a person is nothing more Geneticization refers to the ongoing process by which pri-
than a product of their upbringing. A list of stories ority is given to searching for variations in DNA sequences
tells us nothing about the importance of the role they that differentiate people from each other and to attributing
242 A DAM H EDGECOE

some hereditary basis to most disorders, behaviours and Condit, C.: 1997, Public Discourse About Genetic Blueprints:
physiological variations (including such things as schizo- Audience Responses are Not Necessarily Deterministic or
phrenia and high blood pressure as well as the ability of Discriminatory. AAS Symposium, 17/2/97.
children to sit still while watching television and of adults Condit, C. and M. Williams: 1997, Audience responses to the
to quit smoking) . . . In this sense, geneticization is a process discourse of medical genetics: Evidence against the critique
of colonization with genetic technologies and approaches of medicalization, Health Communication 9(3), pp. 219
applied to areas not necessarily-or even apparently-genetic 235.
(1994, pp. 1314). Condit, C., N. Ofulue and K. Sheedy: 1997, Determinism
2. Expansion of prenatal diagnosis techniques . . . and and mass media portrayals of genetics, American Journal of
expanding professional definitions of what should be dia- Human Genetics 62, pp. 979984.
gnosed in utero, attest to this technologys role in the Donchin, A.: 1996, Feminist critiques of new fertility tech-
process of geneticization (1991, p. 21). nologies: Implications for social policy, Journal of Medical
3. Lippman (1994) for example is exclusively focused on Philosophy 21(5), pp. 475498.
health care technologies and is interested in a number of Duster, T.: 1990, Backdoor to Eugenics. London: Routledge.
fundamental concerns related to womens health and health Edlin, V.: 1987, Inappropriate use of genetic terminology in
care (1994, p. 9). medical research: A public health issue, Perspectives on
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Citation Index and 6 on the Arts and Humanities Cit. Index. Feldman., D. and A. Tauber: 1997, Sickle cell anemia: Reex-
5. 21 on the SCI, 42 on the SocSCI and 1 on the Arts and amining the first molecular disease, Bulletin of the History
Humanities CI. of Medicine 71(4), p. 623, Winter 1997.
6. See Lippman 1991, footnote 55, p. 27: There is an Fox, R.C.: 1988, Essays in Medical Sociology. New Brunswick:
extensive literature on medicalisation . . . in which this dis- Transaction books.
cussion is rooted and from which it derives its guidance. Hoedemaekers, R. and H. ten Have: 1997, Geneticisation: The
She then goes onto cite Zola (1972, 1977). cyprus paradigm, The Journal of Medicine and Philosophy
7. Illichs (1990) work Limits to Medicine is the definitive ver- 23(3), pp. 274287.
sion of his earlier work 1975 work Medical Nemesis: the Horrobin, D.F.: 1978, Medical Hubris: A Reply to Ivan Illich.
Expropriation of health which was revised in the light of Edinburgh: Chuchill Livingstone.
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8. from the Greek; iatro for physician, and genesis mean- How Genetic Information Is Produced and Manipulated by
ing origin; hence disease originating with the physician. Scientists, Physicians, Employers, Insurance Companies,
9. There is a section of their book called The Blueprint of Educators, and Law Enforcers. Boston: Beacon Press.
Destiny: The popular appeal of genetics focussing on Illich, I.: 1990, Limits to Medicine. Medical Nemesis: the
the oracle of DNA, the blueprint of destiny lies partly Expropriation of health, London: Penguin.
in its image as a predicitve science (p. 165). Janzen, J.J.: 1982, Medicalization in comparative perspect-
10. writers . . . tend to evoke blueprints . . . as the predominant ive. In: M.W. de Vries, R.L. Berg and M. Lipkin (eds.),
metaphor for genes and DNA . . . [but] . . . The blueprint The Use and Abuse of Medicine. New York: Praeger, pp. 3
is not an appropriate metaphor for human biology . . . In 18.
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models they use rather than a description of the ways in of disease, Diskussionspapier, 1-93 Hamburger Institut fr
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12. For a detailed description of the methodology, see Condit Lippman, A.: 1991, Prenatal genetic testing and screening:
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13. Very close to Dusters time period. Journal Of Law and Medicine 17(1/2), pp. 1550.
14. Personal Communication 5/12/97. Lippman, A.: 1992, Led (astray) by genetic maps: The carto-
15. The inappropriate and meaningless nature of quantative graphy of the human genome and health care, Social Science
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Lippman, A.: 1994, The genetic construction of prenatal test-
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