Risk and Biomedicalization

“Marking Populations and Persons at Risk: Molecular Epidemiology and Environmental Health” – Sara Shostak

Three questions guide Shostak’s chapter: how did molecular biomarker research emerge? How is molecular biomarker research applied in environmental epidemiology? And, what are the consequences of molecular biomarker research for the biopolitics of environmental health and illness? (142).

For clarification purposes, I’d like to first provide a few definitions.

1. A biomarker is defined by Hanson and Osborn as the “measurable characteristics that indicate normal biologic processes, pathogenic processes, or pharmacologic responses to therapy.” These can include physiological measurements (heart rate, blood pressure, and performance status), clinical chemistry measurements (cholesterol and other blood tests), protein measurements (antigens or hormones), and clinical images (like x-rays or mammograms).

2. Hanson and Osborn also write that molecular biomarkers are a newly emergent way of reading genes/genomes/chromosomes/DNA which can “provide scientists with a ‘parts lists’ containing instructions for how a cell builds, operates, maintains, and reproduces itself while responding to various environmental conditions.” Because of these advents provided by discovering and studying molecular biomarkers, “researchers now can approach questions systematically and on a much grander scale study all the genes expressed in a particular environment or all the gene products in a specific cell, tissue, organ, or tumor.”

3. The British Medical Journal defines epidemiology as “the study of how often diseases occur in different groups of people and why.” It is the “information used to plan and evaluate strategies to prevent illness and as a guide to the management of patients in whom disease has already developed.”

4. Molecular Epidemiology, first used in a 1973 publication, originally entailed the ways that “molecular biological techniques” are used “to study particular disease vectors or ‘agents’ of disease” (246). Now, molecular epidemiology can be used as indicators of “future events in human biological systems at the molecular or biochecmical level” (246). For example, this study by Carrilho et al. shows how patients undergoing haemodialysis therapy are at a greater risk of susceptibility for contracting Hepatitis B based on reading fluid contaminants. This example falls into line with understanding how molecular biomarkers can provide epidemiologists with not only a “means of more precisely identifying individual and subpopulation risks,” but also with a means of elaborating “precisely those pathways” of risk turning into reality (248).

Of particular concern to epidemiologists are the ways that biomarkers can be used to “ascertain three types of risk: environmental risks (exposures), acquired risks (effects of exposures), and inherited genetic risks (intrinsic genetic susceptibilities)” (243). Though there are historical efforts to identify, assess, and affect environmental risks, there is only more recently a shift from the outward to the inward. In other words, a connection is established between the environment and the inner-workings of the human body. As a result of this shift, distinctions between the following become extremely complicated:

· treatment and prevention and “risk reduction”
· public health and private choice
· the individual and the state
· knowing and governing
· biology and power
· thought and practice
· the present and the future

Shostak describes how one of the most useful shifts in studying molecular biomarkers is the movemement from looking inside the biological subject’s body to, instead, understanding the “chain of events leading from exposures to outcomes” (247). That is to say, epidemiologists can “make new claims about the relationships between conditions external to and processes inside of the body” based on tracing exposures and distinguishing how one “handles that exposure” (250).

The ultimate goal of researchers who investigate molecular biomarkers to transform their findings into actions geared toward public health, including prevention vis-à-vis “warning systems” which can identify, observe, measure, trace, understand, reduce, and contain exposure itself and/or risks of exposure. The object of analysis is “measurable objects inside organs, tissues, and cells” (253). 3 Types of these are: markers related to enzymes, markers of genetic difference, and markers of preexisting conditions (253). An important shift, then, not only takes place in looking to exposures instead of (or alongside) the inside of the body, but also takes place in the language employed to discuss these happenings: “You have emphysema,” thus, becomes “You’ve got one hundred thousand deformed proteins” (254). This language becomes one piece of a much larger puzzle that transforms persons into “subjects of self-surveillance and biomedical interventions” designed to minimize risk and to promote prevention (256).

A Case Study: “Breast Cancer Risk as Disease” – Jennifer Ruth Fosket



Fosket’s essay on breast cancer risk and disease is a useful case study to explore questions of molecular markers, risk, health, and biomedicalization. Fosket’s chapter is concerned with the role that pharmaceuticals and chemoprevention play in biomedical practices.

Chemoprevention “is the practice of ingesting pharmaceuticals or nutraceuticals to prevent disease” (331). Chemoprevention in terms of breast cancer is a recent advent, and as Fosket points out, “with biomedicalization, it is no longer necessary to manifest symptoms to be considered either ill or even ‘at risk’” (331-332). A state of normalcy no longer exists: everyone is now, somehow, not normal and, thus, is a pre-packed candidate for self-surveillance and/or health research.

In this framework, breast cancer becomes a fertile site for exploring question and controversies about how this all comes to be: to some extent, we are less concerned with treating and/or curing breast cancer. Instead, we are concerned with treating breast cancer risk. Risk not only undermines a state of normalcy and/or a state of being ill: risk itself becomes, simultaneously and paradoxically, the normalcy and the state of being ill and the disease itself. A few points become important:

First, chemoprevention for breast cancer (and, possibly other diseases) “enters the scene at a time when little else exists to prevent the disease (and, I would add, cure the disease) and uncertainty dominates the identification of breast cancer’s risks” (333). This is an attractive proposition because chemoprevention becomes a means to disguise or even replace efforts to cure diseases which might either be incurable or there is no real market interest in curing. All of this unfolds, as Fosket puts it aptly, “against a backdrop of uncertainty” (334).

Second, there is ambiguity about the word “prevention” and all that it can possibly entail. Primary prevention essentially refers to preventing the cancer in the first place, while secondary prevention involves detecting (i.e. “early detection) cancer at its earliest and most treatable stages (334-335). Betty Ford’s public breast cancer scare and mastectomy not long after her husband became president in 1974 is a key historical moment which points to the adoption of public language of “early detection.” In 1975, she gave a speech to the American Cancer Society, speaking candidly about her experiences: “I just cannot stress enough how necessary it is for women to take an active interest in their own health and body,” she said.

Third, the conception and implementation of tamoxifen, the only breast cancer chemoprevention drug approved by the FDA, is a viable example of the complicated distinctions between treatment and prevention. As an estrogen-mimicking drug, there have been a number of controversies related to tamoxifen. These include: how in the process of addressing one risk, another risk can arise; ethical questions about how you test drugs on healthy subjects; questions about how you select test subjects; the notion of “informed consent” and test subjects; the nature of warning labels; exclusion of certain groups of people in test trials; and so on.

In the end, tamoxifen was approved by the FDA, but not as a form of prevention: it was approved as a “risk reduction” (348). With the approval of tamoxifen, “treating risk with pharmaceuticals increasingly came to be seen as a legitimate, feasible, and worthwhile means of preventing disease both in the realm of breast cancer and more widely” (349).

Discussion Questions:

1. How do we communicate about risk? There are entire centers and areas of study dedicated to “risk communication.” What do you perceive to be the greatest challenges to communicating about risk and why?

2. Take a look at this website for a company called Pharmaceutical Product Development, Inc. Look over the information for clinical volunteers: who is eligible, what to expect, the testimonials of volunteers, etc. How does the language constitute the volunteer into a subject of the study and something beyond the study? What kinds of ethical questions are raised?

Rose Chapters 5 & 6

Chp 5: Biological Citizens

Nikolas Rose argues that a new type of citizenship based on biology is emerging “in the age of biomedicine, bio-technology, and genomics” (p. 131). There is a transformation from the binding nationalist forms of citizen identity to one that extends from the realms of the individual and family to transnational dimensions. Value systems appear to be changing as a population’s resources move from the collection of individuals to the group’s genetic characteristics. “Biological citizenship is both individualizing and collectivizing. It is individualized, to the extent that individuals shape their relations with themselves in terms of a knowledge of their somatic individualality…Biological citizenship also has a collectivizing moment…Biosocial groupings-collectives formed around a biological conception of a shared identity” (p 134). Within these transitions the genetic citizen, through education, takes on the “eugenic” responsibility of the early twenty century state of maintaining one’s own heredity. The state role in managing the character and make up of a nation’s blood and race finds its form in public health measures, which influence medical routines through promotional programs. “Making up biological citizen also involves the creation of a person with a certain kind of relation to themselves…the language with which citizens are coming to understand and describe themselves is increasingly biological” (p. 140-1).

The Commentor from the audience sounds strangely familar



As patients or probable pre-patients, biological citizens learn how the drugs they are prescribed work on the molecular level and are asked to become active in their own recovery. “Activism and responsibility have now become not only desirable but virtually obligatory – part of the obligation of the active biological citizen, to live her or her life through acts of calculation and choice” (p. 147). Those who have a disease are responsible to educate themselves and others in way that not only contribute to the cure but increase awareness about their condition. The biological becomes political. “The regulated political economy of health – consisting of relations between the state apparatus, scientific and medical knowledge, the activities of commercial enterprises and the health related consumption of individuals – is being reshaped, as the potentialities embodied in life itself become sources of value” (p. 150). Concepts of human life are transformed as life itself enters the marketplace creating a “biocitizen-consumer of health.” Rose concludes with the obligations that this economy of health places on these new consumers: “the active responsible biological citizen must engage in a constant work of self-evaluation and the modulation of conduct, diet, lifestyle, and drug regime, in response to the changing requirements of the susceptible body” (p. 154).

Chp 6: Race in the Age of Genomic Medicine

Nikolas Rose begins with a critical question: “Would the genomics of the twenty-first century resurrect, or finally lay to rest, the scientific racism that has played such a formative and bloody role in the history of our present?” He argues that in order to address these concerns the debate has to transcend racial and biological understandings of the past. The current systems do not view race as a deterministic and closed identity, but as “an unstable space of ambivalence between the molecular level of the genome and the cell, and the molar level of classifications in terms of population group, country of origin, cultural diversity, and self-perception” (p. 161).



Rose examines one of the primary means that a states uses to classify and categorizing individuals into race populations, the census. The naming of groups becomes a site of political contention as racial categories are contested and/or recognition as a race is sought to gain resources and equality. Through government sponsorship of research, primarily NIH grants, these classifications found their way into the realm genetic research. “These census categories will come to organize the shaping of scientific truth, not only the techniques for selection of samples and collection of data but its analysis and the search for differences” (p. 174). As genetic technologies have advanced, bio-communities made up of specific races, lineages or groups of individuals who share a common disease have offered their genetic selves to commercial research companies in order to solve their community’s biological issues. Rose suggests “that the forms of collectivization being shaped in the links of ethnicity with medicine are not those of racial science but those of biosociality and active biological citizenship” (p. 176). The quest to discover one’s identity in regards to a community is not raced based but a result of being a territorialized social citizen. People want to know where they came from and who they are in relation with biologically and socially.



Pharmaceutical corporations, however, have found ways to turn race based genetic differences into capital. NitroMed capitalized on these differences, “by claiming to tailor therapies to the genetic profiles of ethnically identified consumers, and enabling them to repatent the drug for African Americans in 2000, thus extending it patent life” (p. 182-3). While there is resistance to this racialization of drugs in America, “the belief that drugs act differently act differently in different populations is already widely accepted in many countries in Asia” (p. 183).



How difference is governed is changed as our understandings of individuals and populations in terms of genetics grow. While there are socio-economic variables connected to risk and susceptibility, ancestral and geographic origins should also be part of the equation. “New kinds of biosocial associations and communities increasingly define their citizenship in terms of their rights (and obligations) to life, health, and cure and these active biological citizens demand that the particularities of their conditions be given weight in genomic biomedical research and the development of therapeutics” (p. 185 -6).

Discussion Questions

1) How do you see yourself in terms of Biological Citizenship (language, activities, knowledge, regulations, communities)?

2) One of the primary debates in making population specific drugs appears to be, "What has more influence socio-economics and enviroment or ancestral genetics?" The answer to these questions might not only effect how populations are viewed, but also the resources allocated via the government and/or the market. Using an example, what might be some consequences of life itself becomeing part of the marketplace in terms of what Rose calls pharmacogenomics?

So…here it is 5:30 in the morning and I can’t sleep. Several thoughts
have entered my mind and I can't seem to post them as a comment so here is a brand new post dedicated to my early morning ponderings.
First, I am certain that every one of us in this class
has thought to ourselves at one time or another, “some people just shouldn’t
have kids.” This reason(s) for this thought include, but are not limited to,
general bad parenting (lack of supervision, extreme discipline or lack of,
etc), addiction issues, abuse, health disorders, physical attractiveness, and
mental capabilities. The list goes on and on. I think most people would agree
that the best if not the only way to stop this reproduction of undesirability
is to prevent people from reproducing. How many times have we heard some
version of “anyone can have a baby, but you have to pass a test to drive a car.”?
The problem with genetic discrimination and sterilization arises when WE are
the ones put on the undesirable list. That is when things are not right or not
fair or infringe on our freedoms. Yet, until we make the list, we are
comfortable judging other people’s decisions to reproduce. With this in mind, I
began to think of my own reproductive status. Why don’t I have any children?
The very first answer that comes to mind is that I am not married. So what?
Well, first off I do not want to do the work of raising a child by myself, but
probably more importantly, I do not want the stigma attached to being a single
Mom despite its wider acceptance these days. Isn’t my unwillingness to be
scrutinized for my reproductive behaviors in a very really sterilizing me? I
may say that choosing birth control is a voluntary decision, but in actuality
it is not. It is one that I have made because society told me to do so.
After considering my personal choices, I began to think of
my niece, little Carolynn. As a few in the class know, she is special needs to
a very large extent. Although she is almost 21 years old, she operates on 4
year old level (or so). She has all the functioning hormonal capabilities of a
21 year old without the mental capabilities to fully understand them or at
least not the verbal capabilities to express her understanding. What would
happen if somehow she got pregnant (this of course would be an extreme
situation and likely require some form of abuse, but nevertheless it could
happen)? What would my sister do? Certainly she could not allow Carolynn to
carry a pregnancy to term. Carolynn’s body may not even be able to do so, but
if she could, what would happen to the baby? Would it have the mental
capacities of a “normal” person? Who would take care of it? My sister? Me?
Adoptive parents? It is a terrible situation to contemplate but also a strong
example of a situation where sterilization seems advantageous (at least to me).
After considering my niece’s situation, I began to think about
cases where HIV positive people were prosecuted for nondisclosure of their
illnesses. (I do not know how I made this leap, but nonetheless.) How is this
life threatening illness different from genetic diseases? Why is it a criminal
offense to have sexual relations (without disclosure) when you are HIV
positive, but not when you sickle cell anemia, ms, breast cancer, or other
disease that is hereditary? How many people know they are predisposed to an
illness or disorder and still choose to have children? The odds be damned! The
differences do not seem that far apart to me. Is the simple answer to this
question ignorance? It seems to me that is the option many have chosen. I would
rather not know if I carried some deadly illness inside me. That way, I could
live a happy life (albeit not likely a very long one) without being preoccupied
and constantly reminded of my impending death. And more importantly, police
officers would not storm my bedroom looking to arrest me for passing on my
illness and premature death. While ignorance is no excuse under law for every
other crime, it is for genetics.
I will end this post now with the thought that the questions
we examine in class are literally the ones that keep us up at night, at least they keep me up but maybe I'm avoiding Candyman. It is too early to know if these thoughts will spark debate later on in class today, but at least they are out of my head and I can get back to sleep!

Risk, Governmentality and Biology

Risk, governmentality and biology act as fundamental elements in todays restructured neo-liberal sense of governance, which dominates contemporary culture. Specifically, this week’s readings explore many issues and consequences arising due to innovations in biomedicine, the predominance of mood-altering drugs, genetic developments, the collusion of insurance and risk, and preventive medical strategies. All of these factors act as catalysts, in the transformation of traditional social and moral norms historically attribute to life itself.

An Emergent Form of Life?
Nikolas Rose argues that developments in medical biotechnology create a myriad of theoretical questions. Rose explains that, “many social theorists, bioethicists, and philosophers worry that biomedical knowledge is effacing the distinction between the natural and the artificial and, in doing so, is raising fundamental questions about human nature, free will, human dignity, and crucial moral values” (Rose, 77). Here in the crux of the neo-liberal governmental rationality, the very essence of what it is to be human becomes blurred. Rose introduces, Leon Kass and colleagues, who reported the President’s Council on Bioethics in 2003. These authors note a dramatic shift in medicine over the last two centuries. Kass and his team identify four particular capacities in which medical biotechnology is now moving beyond therapy to pursue goals of augmentation or transformation of life; including:

I. Better children- prenatal diagnosis, embryo selection, genetic engineering of embryos, and behavior modification with drugs especially in relation to ADHD
II. Superior performance in sport
III. Ageless bodies—the whole range of technologies designed to increase the healthy human lifespan
IV. Happy souls—memory alteration and, in particular, mood improvement through the SSRI family of drugs

Additionally, Rose explores The Future of Human Nature, by Jürgen Habermas.Habermas shares similar concerns as Kass and his contemporaries regarding contemporary biomedicine. Explicitly, Habermas focuses on the issue of reproductive genetics. Reproduction acts as a biological function that is rapidly changing, as critical moral decisions transcend into a new politicization of life itself. One form of reproductive genetics is the emergence of the prepersonal life. Rose defines the prepersonal life as that “of the child to come constraining the ethical freedom of the genetically modified person by undermining their capacity to see themselves as the undivided author of their own life” (Rose, 78). This represents the ideology of optimization as it defines contemporary biopolitics, relating optimization of life itself to two related issues: susceptibility and enhancement. Now, individuals can actively manage the human body according to susceptibility and enhancement.

Susceptibility, according to Rose, “indexes the multitude of biomedical projects that try to identify and treat persons currently without symptoms, in the name of preventing diseases of pathologies that might manifest themselves in the future” (Rose, 82). That is, the individual becomes a pre-patient in terms of susceptibility. “Protodiseases” also emerge. Rose defines a protodisease as “a pathology revealed by diagnostic tools revealing the previously invisible” (Rose, 84). Enhancement, “refers to the attempts to optimize or enhance almost any capacity of the human body or soul—strength, endurance, longevity, attention, intelligence—to open it to artifice and include its management within the remit of biomedicine from bench to clinic and marketplace” (Rose, 82).
Similarly, the individual now possesses the capability to enhance or reshape his or her body through pharmaceuticals and other measures seeking to optimize the body. Rose identifies enhancement as possessing an element of restoration. Through intervention, the individual feels as though he or she can restore the body to a natural or favorable state. A new molecular scale emerged alongside contemporary biology. This focus is the basis on which life is visualized and acted upon. Numerous processes arose as the molecular gaze of the human body widened including; reverse engineering of life, its transformation into intelligible sequences of processes that can be modeled, reconstructed in vitro, tinkered with and reoriented by the molecular interventions to eliminate undesirable anomalies and enhance desirable outcomes” (Rose, 83). In other words, the individual becomes malleable, subject to intervention so that he or she may have a healthy future or outcome. Due to advances in biomedicine, Rose further argues that “any element of a living organism—any element of life—can be isolated, its properties identified, mobilized, manipulated, and recombined with anything else” (Rose, 83)..

Rose notes that Hans-Jorg Rheinberger furthers his own exploration of recent innovations in contemporary biopolitics. Rheinberger suggests that the human race has shifted from an “age concerned with representing organisms and their processes—an age concerned with discovery—into a technological age, one concerned with intervention, whose telos is that of rewriting and transforming life” (Rose, 83). Although Rose does not agree with Rheinberger’s argument fully, he finds the central argument to be accurate. Rose proposes that life forms and forms-of-life that persons inhabit resulted in the merging of bios and zoë. In contemporary neo-liberal governance, the bios merged with the animal nature of zoë as medicine and the optimization of health has become a highly politicized in contemporary society.

As the human body is no longer a natural given, Rose argues that a new ontology of the individual now dominates biomedicine. He furthers, “ The multiple transactions between expertise and subjectivity, and the multiple injunctions and managed desires to reform and remake ourselves through calculated intervention in the name of our authenticity, self-realization, and freedom, have been central to the government of self in advanced liberal democracies” (Rose,105). That is, through optimization interventions of the human body; individuals provide an economic opportunity where individuals become consumers in an economic marketplace where an emergent form of life if quite possible.


At Genetic Risk
In, At Genetic Risk, Rose explores the notion of risk and its application to genetics. Specifically, Rose examines the consequence of being ‘at genetic risk’ as ‘mutations in personhood.’
Persons become obligated in the present to act in relation to potential futures now observable. It is in this capacity that discourses and practices in genetics now relate to risk. Rose introduces a new variation of genetic risk stating, “Various forms of risk thinking, the availability of predictive genetic testing introduces a qualitative new dimension into genetic risk, creating new categories of individuals and according genetic risk a new calculability” (Rose, 107). Essentially, Rose treats these phenomena as the surveillance or treatment ‘in the name of prevention. Additionally, genetics also closely mirror what Rose terms, ‘contemporary practices of identity.’ In this sense, life becomes a strategic initiative obligating the individual to maximize his or her life and the subsequent lives of decedents to come. Rose explains, “As life has become a strategic enterprise, “the categories of health and illness have become vehicles for the self-production and exercise of subjectivities endowed with the faculties of choice and will” (Rose, 107-108). The individual body, now the subject of ‘molecular gaze’, has in turn, labeled susceptibility of disease as a molecularized concept as genetic risk is now largely a molecular matter rather than that of the soma or of the flesh.

Somatic individuality, according to numerous theorists, represents a ‘whole-scale geneticization of identity’ (Rose, 109). However, Rose argues that this geneticization argument is deceiving. First, Rose argues that contemporary medicine does not subject an individual; suppressing and relinquishing the individual’s freedom. Instead, genetic identity acts as a creator, producing subjects out of the human individuality. Once patients, individuals emerged in contemporary medical practice as active subjects and consumers of treatments and cures. This ideology is future-oriented. That is, genetics act not only to trace historical and ancestral genetic links but also to prevent future illness and. Asymptomatic patients now emerge as ill individuals but it is also crucial to note that illnesses have become much a ‘family matter.’ Rose identifies these pre-patients as belonging to a genetic network. He further explains, “The subject genetically at risk may re-think his or her relation to current family, lovers, potential and actual spouses, children, grandchildren, and so forth—in terms of the issues of risk and inheritance” (Rose, 112). This often results in a reshaped lifestyle, where the pre-patient individual acts in order to prevent illness. Additionally, Rose notes that identity practices lie in a complex web in which the geneticization of identity becomes entangled.

Next, Rose, using Novas’ three distinct periods in which he finds mark the shifts that have taken place in the field of genetic advising. Novas identifies the first ‘eugenic period’ as running thought the 1930s and 1940s. This period stressed the reshaping of ‘voluntary’ individual reproductive decisions using contemporary eugenic considerations. Later in the period, film and propaganda acted to reshape individual’s choices regarding reproduction. Particularly, the first eugenic age represented the idealized assessment of good genes and bad genes, which experts used to advise reproduction based on hereditary genetic risks. Second, the 1950s through the 1970s marked the second ‘eugenic period.’ In an attempt to distance eugenics as used by the Nazis in Germany, experts in this era urged that preventing genetic disease should be a ‘voluntary measures.’ Optimization of health became the standard, specifically through prevalent discourse urging the prevention of birth defects. As Rose notes, “Novas argues that during this period genetic counseling was redefined as a form of guidance to help relieve anxieties, fears and inner tensions of being provided with genetic risk information” (Rose, 115). Third, the period lasting from the 1970s to contemporary times exemplifies a eugenic period, which Novas urges notes the emergence of a new form of ‘psychological counseling,’ which became dominant then and remains so today. Rose explains that in this model the, “identification of genetic risks has become bound up with a concern to maximize life chances and improve quality of life; in order to do this, genetic counseling was no longer to be exclusively concerned with the prevention of genetic disease, but must be involved in the communication of genetic risk” (Rose, 115). Psychosocial genetic counseling, today, stresses the modification of an individual’s lifestyle. This assumes individual autonomy and prudent action for their individual future but also for future decedents. As persons ‘at risk’ emerged, governance ostracized and marginalized genetically risky persons based solely on their individual genetic makeup. This especially applied to ‘populations at risk’ as governances sought to alleviate bad genes leading to genetic discrimination.

Genetic discrimination represents the use of individual genetic information discriminatorily based only on the individual’s genetic makeup in comparison to the “normal genotype” (Rose, 117). Rose notes that the “a new underclass based on genetic discrimination” was threatening to researchers in the early 1990s (Rose, 117). Additionally, by insurance policies further genetic discrimination through monetary schemes based on an individual’s level of risk. Increases in genetic information resulted in a general shift by insurance companies to practice risk segmentation. Rose explains, “ While insurance can acts so as to socialize risk, the current tendency has been to utilize knowledge about populations and information about individuals to ‘unpool’ risks and to allocate individuals to tightly defined risk categories” (Rose, 123). Now, individuals become calculable units within a network of risk and prudent behavior is required in order to promote further health by acting ‘genetically responsible.’

Individuals act responsibly using genetic information as neo-liberal governances construct the human life as a project , “framed in terms of the values of autonomy, self-actualization, prudence, responsibility and choice” (Rose, 125). Here, Novas identifies four distinct precepts of technologies of the self:, which are created through individuality of contemporary medicine. These include:
I. The location of a molecular- genetic identity:
II. A domain of ethical problemization:
III. A new relation to expertise:
IV. Formation of life strategies :
All of the above characteristics of technologies of the self are future-oriented while acting in the present. One must be genetically responsible so not to plague future generations with illness or abnormality. Individuals now adopt a genetic personhood . Summarily, Rose argues that genetic risk is evolving into a governmental practice politicizing individual human lives.



Insurance and Risk
The term, insurance, possesses multiple meanings and different forms of practice. Francois Ewald identifies the term insurance as an institution, an abstract technology, the insurance as form and as a technology of risk. First, insurance as an institution refers to the various companies managing a wide range of insurance liabilities. Insurance institutions apply to both persons and property, which creates distinct institutions. These organizations serve different purposes as well as attract different patrons. Second, insurance acts as an abstract technology. This view assumes that insurance technology is ‘an art of combination’ (Ewald, 197). Ewald elaborates this idea stating, “Considered a technology, insurance is an art of combining various elements of economic and social reality according to a set of specific rules” (Ewald, 197). Using utility-effect strategies, insurers use insurance as a technology based on the technology of risk. Third, the idea of insurance as a form refers to the numerous ways various insurance institutions are shaped. Fourth, insurance becomes a technology of risk in contemporary society.
Risk as it applies to insurance holds three significant characteristics Ewald states that, risk is ‘calculable, collective, and it is a capital.’ The calculability of risk essentially assumes that it is possible to evaluate probability. That is, the idea of insurance centers on both a ‘statistical table which establishes the regularity of certain events’ and ‘the calculus of probabilities applied to that statistic.’ In other words, this formulaic model results in the actual chances of an event occurring. Making risk a specific function in predicting action regardless of intent or will among the individuals evaluated. Second, risk is collective as events often affect a population or groups. Individual risk is moot in this scenario as risk is only calculable as it encompasses a population. Through selection and division of risks, insurers act to socialize risks making each individual a part of the collective body. According to Ewald, “insurance provides a form of association which combines a maximum of socialization with a maximum of individualization” (Ewald, 204). Ewald deems this form as reconciling society-socialization and the issue of individual liberty, allowing insurance to succeed politically. In sum, Ewald addresses the notion of risk in todays society as it drives individuals to act in the present to secure an illusory future good



From Dangerousness to Risk
In From Dangerousness to Risk, Castel explores preventive strategies used especially in the United States and France, which transform traditional mental medicine and social work. The subject dissolves, as he was once a concrete individual. Now the individual enters a realm in a ‘combinatory of factors’. Particularly, one enters ‘the factors of risk.’ Risk begins to establish itself as it channels flows of population through the establishment of numerous factors that act as liabilities in the future production of risk. According to Castel, the principal shift in social work and medicine that has taken place over the past century as the, “transition from a clinic of the subject to an epidemiological clinic, a system of multifarious but exactly localized expertise which supplants the old-doctor-patient relation” (Castel, 282). That is, there is no longer a direct relation between the patient and the doctor/ technician as individuals become statistical information channeled through numerous networks comprised of experts and administrators. It is in this period that dangerousness ceased to dominate medicine as preventive strategies replaced former notions of patient care to an ideology based on risk. It is through prescribed preventive measures that one actively seeks to prevent future abnormalities. Interventionist techniques act to guide and assign individuals according to abnormalities.

The transformation from dangerousness to risk over the past century occurred largely due to the heightened postulation by experts of future events. Individuals now act in the present in order to secure a favorable future. This future-oriented ideology sought to control unpredictabilities and liabilities of future actions. Classic psychiatry began using two notable forms of preventive strategies; confinement and sterilization. Confining an individual sought to prevent and neutralize an individual who may act dangerously at some point in time. Sterilization, on the other hand, is capable of wholly eradicating future risks. Once sterilized, the individual cannot pass on his or her abnormality to future generations. Eugenics also finds reason in risks rather than danger. Intervention then occurs based on “preservation of the race” to protect descendants much like sterilization. http://youtu.be/qaQQHuwqg6A

Castel introduces a new mode of surveillance, which he terms, systematic predetection. Systematic predetection seeks to influence individuals to anticipate and prevent a future pathology or abnormality using preventive practices. In the process, the subject ceases to exist, as individuals become “factors and statistical correlations of heterogeneous elements” (Castel, 288).
Castel identifies two consequences of the shift in medicine and social work over the past century.

I. The separation of diagnosis and treatment, and the transformation of caring function into an activity of expertise
II. The total subornation of technicians to administrators

As new forms of control materialize in today’s neo-liberal society, an ‘unified apparatus linked to the machinery of the state’ materialize as maximizing returns while treating populations. However, this apparatus marginalizes lower class individuals, as these persons do not create profit. Consequently Castel explains, “ The profiling flows of populations from a combination of characteristics whose collection depends on an epidemiological method suggests a rather different image of the social; that of a homogenized space composed of circuits laid out in advance, which individuals are invited or encouraged to tackle, depending on their abilities” (Castel, 295). Therefore, the marginalization of certain populations becomes an organized force within the social realm directing lower class populations who have no opportunity to insure against liability as the wealthy may This results in a dualistic situation whereby the wealthy benefit while the poor are continually marginalized and controlled by the notion of risk using preventive strategies.

Discussion Questions:

I. According to Rose, genetic discrimination is growing, making individuals into statistical data. How might one solve the marginalization of lower-class individuals especially in light of drastic measures such as sterilization?

II. Following the idea of insurance and risk proposed by Ewald, how much is the human body actually worth? In other words, how would you price yourself or your family? This poses an interesting theoretical debate as loss ensued are never wholly reparable.

The Pinking of America

Here is a fantastic article on NYT on Breast Cancer Awareness Month and Pinking of America

and

Here is the article by Barbara Ehrenreich "Welcome to Cancerland!" that I referenced last time in class

and

Here is her article title "Pathologies of Hope" - a worthy read

Article Examining Company Mission Statements

Global Business Citizenship and Voluntary Codes of Ethical Conduct
Author(s): Jeanne M. Logsdon and Donna J. WoodSource: Journal of Business Ethics, Vol. 59, No. 1/2, Voluntary Codes of Conduct forMultinational Corporations (Jun., 2005), pp. 55-67

Trailer Temple: In Time - Trailer - Justin Timberlake's new movie

Trailer Temple: In Time - Trailer - Justin Timberlake's new movie: Title: In Time Director: Andrew Niccol Cast: Justin Timberlake, Amanda Seyfried, Cillian Murphy Release date: 28 October, 2011 Plot:...

In the future, people stop aging at 25 and have to work in order to buy more time for themselves. However, after winning a fortune of time, he must run from the corrupt police to save his life.

Defining Life

Defining Life

In chapter two of Rose (2007), “Politics and Life,” he specifically discusses the terms of contemporary biopolitics: Life, Nonlife, Politics, Biopolitics, Eugenics, Population, Risk, and The New Pastorate. First, Rose discusses “the meaning of life.” Rose discusses how conceptions of the term, life, have changed since the 1800s, noting the rise of biology, which did not exist in the 18^th century; then Rose discusses Foucault’s idea of binary divisions of nature  in the 19^th century as either – the living which is continuously fruitful- or inorganic – the non-living, those who do not produce/reproduce; and lastly, the 20^th century is more conflicting in assertions of life with some scholars viewing the era of “life as information” replaced by “life as organic unity,” Rose agrees with EvelynFox Keller that

a genetic style of thought is giving way to a postgenomic emphasis on complexities, interactions, developmental sequences, and cascades of regulation interacting back and forth at various points in the metabolic pathways that lead to the synthesis of enzymes and proteins. (p. 47).

Rose also asserts that life “in terms of information” has reached its limits and “can no longer capture what researchers do as they represent and intervene in the vital complexities that constitute life at a molecular level” (p. 47). In addition, Rose also discusses the differences between life and nonlife, noting that the lines between these two states of being are not concrete but rather blurred (as he cites the issues concerning organ transplantation), and are subject to political, bioethical, and biomedical debate, along with concentrated capitalization.

Politics & Biopolitics

Using Foucault’s (1978) theoretical framework of political power in The History of Sexuality, Rose emphasizes that politics have to address the vitality of human existence: “the size and quality of the population; reproduction and human sexuality; conjugal, parental, and familial relations’ health and diseases; birth and death” (p. 53). Because of essential relations between managing populations and their characteristics, and the many components of government and their systems of management, Rose uses the term biopolitics to refer to “strategies involving contestations over the ways in which human vitality, morbidity, and mortality should be problematized, over the desirable level and form of the interventions required, over the knowledge, regimes of authority, and practices of intervention that are desirable, legitimate, and efficacious.” (p. 54).

Eugenics, Risk, & the New Pastorate

            Rose notes the different ways in which eugenics has been defined by many scholars throughout the first half of the 20^th century. Rose states that eugenics is comprised of strategic ways of legitimating and making vital the need “to secure the future welfare of the nation by acting upon the differential rates of reproduction of specific portions of the population, so as to encourage the best to procreate and to limit the procreation of those thought to be of lower, inferior, defective, or diseased stock” (p. 54). Central to the idea of eugenics is population. FrancisGalton (1883) coined the term, eugenics, and believed that “the science of heredity is concerned with Fraternities and large Populations rather than with individuals and must treat them as units” (Galton, 1889, p. 35 as cited in Rose). In other words, as Rose reiterates, while the aim is strategically placed on the agency for individual health, this aim ultimately hopes to improve the quality of the entire population, and not just select individuals. Roses discusses Foucault’s concepts of the body politic- eugenics- as to include: population, quality, territory, nation, and race as being an essential part of eugenic discourse, as he gives the example of how Nazi physicians used these terms to promote superior bodies over “inferior” ones.

According to Rose, in eugenics, through a “variety of strategies that try to identify, manage, or administer those individuals, groups, or localities, where risk is seen to be high,” risk thinking has been central to biopolitics for over 150 years (p. 70). Here, risk implies multiple ways of contemplation and acting that “involve calculations about probable futures in the present followed by interventions into the present in order to control that potential future” (p. 70). In the first half of the 20^th century, genetic advising was used in heredity clinics following WWII. Throughout the same century, reproduction risks became a central area in which women were risk profiled by their physician or midwife. Pregnant women already considered high risk due to age or family history, could choose to receive antenatal screening – testing samples of maternal serum for genetic abnormalities; in addition, many of the “feeble minded,” psychiatric patients, and sexual offenders were sterilized.

          Similar to Foucault, Rose also discusses eugenics as pastoral – “a form of collectivizing and individualizing power concerned with the welfare of the ‘flock’ as a whole” (p.73). Rose states that contemporary pastoral power is not managed by the state; rather, this power takes form in a plural and debated field imbedded by the codes defined by different ethical and professional associations and committees, researchers’ empirical analyses, attitudes and policies by employers and insurers, tests developed and advertised by psychologists and biotech companies, self-help organizations advice, and additionally, the perspectives of religious organizations and sociologists. In other words, Rose describes contemporary pastoral power as relational, working “between the affects and ethics of the guider,” the medical professionals, and the affects and ethics of the guided- “patient”- who are making themselves more productive and better citizens of society. Lastly, as we already briefly discussed in class, Rose discusses the problems surrounding the fact that, “once known to fall within a risk group, the individual may be treated – by others and by themselves – as if they were, now or in the future, certain to be affected in the severest fashion” (p.75).

U.S. Healthscapes and Iconography

In chapter three of “Biomedicalization,” Clarke (2010) argues that modern American biomedicalization, along with the rise of medicine and medicalization, are all overlapped “with popular and visual cultural materials, representations, and media coverage of things medical”- which Clarke deems as healthscapes (p. 105). To reiterate, through discourse, healthscapes “focus on all kinds of things medical as forming assemblages, infrastructures of assumptions as well as people, things, places, images and demonstrate “how medicine gained cultural authority” (Clarke, p. 141, p. 106).

For critically evaluating healthscapes, Clarke first notes Jordanova’s (1998) theory that visual imagery exists beyond language in ways still not clearly understood; second, Collier and Lakoff’s  (2005) notion that “(bio)medical framings of ‘regimes of living’ have become deeply naturalized” (p. 107); third, health has “densely elaborated iconographies” (p.107); fourth, medical imaging technologies have depicted the body as seemingly transparent; and lastly, through visual medicine, people “imagine (bio)medicalization.” Throughout the majority of the chapter, Clarke discusses the three eras of healthscapes: 1). The rise of medicine (1890-1945) – cultural products, via mass production and consumption, centered on advertising physicians, the medicine profession, and the life sciences without medical professionals having to put forth much effort to promote themselves; 2). Medicalization (1940-1985) – people having/ and more routinely visiting a family doctor; relying more on advanced medicine; new acts and health insurance policies promoting health benefits; more regularly published books and radio airings on health issues; and “newer media” of television programming and films concerning health; 3). Biomedicalization (1980-Present) – began with the infrastructures of computer and information sciences; health research projects, such as the Human Genome Project; newspaper covers and mystery novels dedicated to biomedical issues; the rise of the era of fictional medical dramas on television; new media focuses on celebrity health; through many cultural forms, patients publicly becoming spokespersons of  their own illnesses; the creation of video, digitalization, and robotics; and websites.

            I think that an important area that Clarke does not directly discuss is social media. The way people think of and can view other women’s ultrasounds has drastically changed since the creation of networks such as Facebook. Ultrasounds are now not simply viewed in the privacy of a gynecologist office (as Clarke notes the pictures are often passed around), but can be posted to millions and millions of people on a social network; thus, posting sonograms online further promotes the idea of fetal personhood as friends may post their comments on the characteristics of the fetus. Also, I think another relevant example is online support groups discussing and promoting different health issues. These groups can persuade inquirers of the benefits of different biomedical issues, such as in-vitro fertilization, genetic testing, and even issues such as vegetarianism. Online support groups offer citizens a way to show they actively care about the well-being of the population by giving helpful advice to those who feel “inferior” in their own health management, etc. 

Questions:

1). In chapter three, Clarke discusses the healthscapes of the biomedicalization era and emphasizes the idea that Altheide (2002) argues that the media produce a “discourse of fear” – “a vigilant awareness that danger and risk lurk at every turn” (p.135). Based on Rose’s assessment of managing risk and Clarke’s analysis of biomedicalization healthscapes, cite a specific health-related example of how you see fear, risk and/or danger being emphasized in culture.

2). In an above post, I posted a link to an upcoming movie that I think represents the idea of eugenics because the citizens are always consumed about their future because they, ultimately, can control if they wish to live longer than the age of 25 and do so without bodily maturing past that age. How do you view examples of eugenics in modern society?