ABSTRACT A key selling point of pharmacogenetics is the genetic stratification of either patients or diseases in order to target the prescribing of medicine. The hope is that genetically ‘tailored’ medicines will replace the current ‘one‐size‐fits‐all’ paradigm of drug development and usage. This paper is concerned with the relationship between difference and justice in the use of pharmacogenetics. This new technology, which facilitates the identification and use of difference, has, we shall argue, the potential to lead to injustice either by (...) the inappropriate use of difference or through the inappropriate failure to use difference. We build on empirical data from a detailed study of the range of options for the development of pharmacogenetics to present a consideration of the ethical issues that surround patient and disease stratification. In it we explore the ways in which the use of pharmacogenetics may lead to the creation of new, genetically stratified, forms of difference and new forms of injustice based on these divisions. We also examine the ways in which existing forms of difference and social stratification may interact with the use of pharmacogenetics. In conclusion, we suggest how an understanding of these ethical issues could usefully inform future policy discussions. (shrink)

Two major reports in the UK and USA have recently sanctioned as ethically acceptable genome editing of future generations for the treatment of serious rare inherited conditions. This marks an important turning point in the application of recombinant DNA techniques to humans. The central question this paper addresses is how did it became possible for human genetic engineering (HGE) of future generations to move from an illegitimate idea associated with eugenics in the 1980s to a concrete proposal sanctioned by scientists (...) and bioethicists in 2020? The paper uses the concept of a regime of normativity to understand the co-evolution and mutual shaping of technology, imaginaries, norms and governance processes in debates about HGE in the USA and UK. It will be argued that interlinked discursive, institutional, political and technological changes have made proposals for the use of genome editing in the genetic engineering of future generations both “thinkable” and legitimate. (shrink)

Genome editing enables very accurate alterations to DNA. It promises profound and potentially disruptive changes in healthcare, agriculture, industry, and the environment. This paper presents a multidisciplinary analysis of the contemporary development of genome editing and the tension between continuity and change. It draws on the idea that actors involved in innovation are guided by “sociotechnical regimes” composed of practices, institutions, norms, and cultural beliefs. The analysis focuses on how genome editing is emerging in different domains and whether this marks (...) continuity or disruption of the established biotechnology regime. In conclusion, it will be argued that genome editing is best understood as a technology platform that is being powerfully shaped by this existing regime but is starting to disrupt the governance of biotechnology. In the longer term is it set to converge with other powerful technology platforms, which together will fundamentally transform the capacity to engineer life. (shrink)

Pharmacogenetics is an emerging biotechnology concerned with understanding the genetic basis of drug response, and promises to transform the development, marketing and prescription of medicines. This paper is concerned with analysing the move towards segmented drug markets, which is implicit in the commercial development of pharmacogenetics. It is claimed that in future who gets a particular drug will be determined by their genetic make up. Drawing on ideas from the sociology of expectations we examine how pharmaceutical and biotechnology companies are (...) constructing, responding to and realising particular ‘visions’ or expectations of pharmacogenetics and market stratification. We argue that the process of market segmentation remains uncertain, but that the outcome will be fashioned according to the convergence and divergence of the interests of key commercial actors. Qualitative data based both on interviews with industry executives and company documentation will be used to explore how different groups of companies are developing pharmacogenetics in distinct ways, and what consequences these different pathways might have for both clinical practice and health policy. In particular, the analysis will show a convergence of interests between biotechnology and pharmaceutical companies for creating segmented markets for new drugs, but a divergence of interest in segmenting established markets. Whilst biotechnology firms have a strong incentive to innovate, the pharmaceutical industry has no commercial interest in segmenting markets for existing products. This has important implications, as many of the claimed public health benefits of pharmacogenetics will derive from changing the prescribing of existing medicines. One significant implication of this is that biotechnology companies who wish to apply pharmacogenetics to existing medicines will have to explore an alternative convergence of interests with healthcare payers and providers . Healthcare providers may have a strong incentive to use pharmacogenetics to make the prescribing of existing medicine more cost-effective. However, we conclude by suggesting that a question mark hangs over their ability to provide the necessary economic and structural resources to bring such a vision to fruition. (shrink)

The U.S. Food and Drug Administration's rationale for supporting the development and approval of BiDil for heart failure specifically in black patients was based on under-powered, post hoc subgroup analyses of two relatively old trials , which were further complicated by substantial covariate imbalances between racial groups. Indeed, the only statistically significant difference observed between black and white patients was found without any adjustment for potential confounders in samples that were unlikely to have been adequately randomized. Meanwhile, because the accepted (...) baseline therapy for heart failure has substantially improved since these trials took place, their results cannot be combined with data from the more recent trial amongst black patients alone. There is therefore little scientific evidence to support the approval of BiDil only for use in black patients, and the FDA's rationale fails to consider the ethical consequences of recognizing racial categories as valid markers of innate biological difference, and permitting the development of group-specific therapies that are subject to commercial incentives rather than scientific evidence or therapeutic imperatives. This paper reviews the limitations in the scientific evidence used to support the approval of BiDil only for use in black patients; calls for further analysis of the V-HeFT I and II data which might clarify whether responses to H-I vary by race; and evaluates the consequences of commercial incentives to develop racialized medicines. We recommend that the FDA revise the procedures they use to examine applications for race-based therapies to ensure that these are based on robust scientific claims and do not undermine the aims of the 1992 Revitalization Act. (shrink)

This paper explores the way in which God as the infinite ground of existence is discerned by the imagination and understanding. The representation of the apophatic divine is facilitated by the working of the human mind, which means that the manifold nature of thinking establishes the presence of God. In the metaphysical speculations of kabbalah and tantra the singular light of Ein Sof and Paramashiva intersects with the human imagination, and is refracted into a multiple display of understanding. So the (...) mind acts as a prism through which God is conceptualized and delineated. It constitutes a mediated envisaging of the Absolute, and the corollary of this perception is the engendering of the divine presence, notably as the feminine Shekhinah and Shakti. In short, in these two apparently different traditions—of kabbalistic and tantric thought—there is a detectably common theme of the notions of activity and force in creation as betokening a feminine representation of God’s being. (shrink)

Academic health centres have historically treated patients with the most complex of diseases, served as training grounds to teach the next generations of physicians and fostered an innovative environment for research and discovery. The physicians who hold faculty positions at these institutions have long understood how these key academic goals are critical to serve their patient community effectively. Recent healthcare reforms, however, have led many academic health centres to recruit physicians without these same academic expectations and to partner with non-faculty (...) physicians at other health systems. There has been limited transparency in regard to the expertise among the physicians and the academic faculty within these larger entities. Such lack of transparency may lead to confusion among patients regarding the qualifications of who is actually treating them. This could threaten the ethical principles of patient autonomy, benevolence and non-maleficence as patients risk making uninformed decisions that might lead to poorer outcomes. Furthermore, this lack of transparency unjustly devalues the achievements of physician faculty members as well as potentially the university they represent. In this paper, it is suggested that academic health centres have an obligation to foster total transparency regarding what if any role a physician has at a university or medical school when university or other academic monikers are used at a hospital. (shrink)

This work is an attempt to explore both the increase in and the breadth of popular collecting in Britain. It does this by examining the contexts of social change over the past 20 years. This change, it is argued, has led to a culture of social and material insecurity, in which collecting is used for the creating and defence of identity. The social theory of Guy Debord is employed as an underlying philosophy in which contemporary popular collecting is interpreted as (...) an expression of a moral value system in a society driven by market forces. The social world and values of collectors are explored through their clubs. These, it is asserted, comprise an alternative society, one in which a legitimization of the collector's activities and preferences can be made and in which they develop a complementary reality. (shrink)

In this paper I shall argue that useful correspondences can be drawn between the role of depiction in showing a view of the world and the realisation that would view God as a picture of experience in the world, since both can be seen to illustrate an art of interpretation. The perceptual insight that is gleaned in mystical-philosophical consciousness converges on the idea of a realm that is marked as divine, and by exploiting mental and linguistic imagery this mindful awareness (...) can be made concrete in the form of a written text, which can be seen to be analogous to a pictorial representation. The writer of a text purportedly sees and knows the domain of divine reality through sensible and conceptual means and then reduces this consciousness to a planar form, which is observable as an artistic rendering. The reader, who is at the same time a viewer, is invited to perceptually and imaginatively attend to the artifact as a manifestation of the experient's understanding of the functional nature of God, and in this apprehension of the divine scenario in the textual picture the interpretative motif of God-in-the-painting is revealed. (shrink)

This paper examines the relation of body, soul, and God in the context of spiritual desire. It connotes a gendered relationship with the nature of divinity. A prime exponent of this mode of realization is Mechthild of Magdeburg, who longingly reaches for God, and employs vivid imagery in describing her quest.

There has been a longstanding interest in discovering or uncovering resemblances among what are ostensibly diverse religious schemas by employing a range of methodological approaches and tools. However, it is generally considered a problematic undertaking. Jonathan Z. Smith has produced a large body of work aimed at explicating this and has tacitly based his model of comparison on metaphor, which is traditionally understood to connote similarity between two or more things, as based on a linguistic or pragmatic assessment. However, another (...) possible approach is cognitive. George Lakoff and Mark Johnson have championed the view of “conceptual metaphor,” which regards metaphor as being pervasive not only in language, but also in thought and action. Indeed, according to them, it basically structures our conceptual operations and hence views of the world through partially mapping knowledge across ontological domains, generally from the concrete to the abstract. I shall argue that a similar mechanism can fruitfully be applied to comparing religious schemas, as based on the postulated relationship between the domains of human and divine, physical and abstract, and as realized through expressions of journeying and reflection. (shrink)

In this paper I consider the way in which divinity is realized through an imaginary locus in the mystical thought of Jewish kabbalah and Hindu tantra. It demonstrates a reflective consciousness by the adept or master in understanding the place of God’s being, as a supernal and mundane reality. For the comparative assessment of these two distinctive approaches I shall use as a point of departure the interpretative strategies employed by Elliot Wolfson in his detailed work on Jewish mysticism. He (...) argues that there is an androcentric bias embedded in the speculative outlook of medieval kabbalah, as he reads the texts through a psychoanalytic lens. In a similar way, I will argue that there is an androcentric bias to the speculations presented in medieval Shaiva tantra, in particular that division known as the Trika. Overall, my aim is to suggest some functional and perhaps structural similarities to the characterization of divinity in these two traditions, through brief analyses of the erotic understanding of the nature of the Godhead. (shrink)

What does it mean to talk of the power of God in relation to the human self? The discourses generated by the Jewish and Christian tradition about the capacity for divinity have been mainly promulgated by men, and have more often than not served to exclude women cognitively, practically, and spiritually. As a result they have been made powerless in the face of God’s presence. It is possible to look to ideas developed in Hindu Tantra for comparative notions of power (...) (shakti) which can redeem the place of God for women. The path of divine consciousness is effectively illustrated by an imaginary and somatic awareness, by a devout attention to the play of light in the soul. In this paper I propose to read the assignment of energy and force within conceptions of divinity through the lens of a poststructuralist realization, using the work of Michel Foucault, Gilles Deleuze and Félix Guattari, and Luce Irigaray. This working paper is basically an exercise in metaphorical writing, and one reader has called it 'creative theology'. (shrink)

In this paper I consider the apparently distinctive outlooks indicated by the mystical thought of Jewish kabbalah and Hindu tantra as they aim at realizing the scope of divine awareness. It is a profound horizon of light that beckons to them, which shows them to be on the verge of touching God. For both traditions there is a demonstrative reflective consciousness by the practitioner in realizing and recognizing the place of God’s being, as a supernal and mundane reality. It is (...) an attempt to grasp that which is otherwise unreachable and unknowable, by pointing to a sublimely felt reality. I argue that there are some phenomenological similarities to the way in which approaching the divine is understood in these two systems, especially in regard to the role of specularity in apprehending and discriminating the place of God. (shrink)

Since its emergence as an academic discipline in the early 1970s, feminist commentary and scholarship has prosecuted a critique of androcentric or sexist (gender exclusive) language, which has to some extent been successful. The struggle by women to occupy a positive linguistic space is continually being challenged by the endemic nature of masculine bias, which is realized through “indirect” or “subtle” sexism in the community. Seemingly innocuous words, like guy/guys, are frequently used to represent both men and women, reminiscent of (...) the previous use of man/men as gender inclusive common nouns. This raises the question of how to account for the persistence of such language use in spite of the fact that attention is regularly drawn to its problematic character. In this paper we approach the matter in a novel way, by appealing to work in the field of cognitive semantics, in particular the conceptual theory of metonymy. We propose that the relationship between the concepts of masculine and feminine as these are typically structured through language is indicative of a metonymy THE MASCULINE FOR THE FEMININE, in which the masculine “stands for” the feminine and in which lexical items are given as inclusive yet in effect refer to one (normative) gender. A corollary is that the feminine is subsumed (really or virtually) by the presence of the masculine and is made to disappear, and only reappears when she needs to be specified within the contextual frame. (shrink)

The ongoing debate about the FDA approval of BiDil in 2005 demonstrates how the first racially/ethnically licensed drug is entangled in both Utopian and dystopian future visions about the continued saliency of race/ethnicity in science and medicine. Drawing on the sociology of expectations, this paper analyzes how scientists in the field of pharmacogenetics are constructing certain visions of the future with respect to the use of social categories of race/ethnicity and the impact of high-throughput genotyping technologies that promise to transform (...) scientific practices. (shrink)

In a recent discussion about how scientific knowledge might potentially change our understanding of the nature and extent of human genetic, cultural, or biological variation, the sociologist David Skinner identified two competing visions of the future: one that was decidedly dystopian, which conjured up a “re-racialized” future, and an opposing utopian future in which the potential for racialized thinking might be finally overcome. We can situate the ongoing debates about the congestive heart failure drug BiDil, approved by the Food and (...) Drug Administration for use only by African Americans, in relation to these differing future prospects.When the FDA announced its approval of BiDil in June 2005, it located the drug, and perhaps the future of pharmaceutical development, within a particular vision of the future, heralding BiDil as “representing a step toward the promise of personalized medicine.” The discourse of “personalized medicine” can be characterized as part of a utopian future, one in which clinicians will be able to make increasingly individualized decisions based on each patient’s genetic makeup so that the drugs they take will be those that work best for them. (shrink)

In this short think-piece we trace the newly emerging and rapidly expanding dimensions and dynamics of the “neuro-complex.” What this amounts to, we suggest, are a series of bio or neuro “convergences” of sorts regarding the brain and mental worlds, which in turn are traceable through what we term the bio-psych, pharma-psych, subjectivity-selves, wellness-enhancement, and the neuroculture-neurofutures relational nexuses. These issues are then illustrated through two brief case studies regarding brain scanning technologies and the problems and prospects of cognitive enhancement. (...) The paper concludes with some final reflections on these matters and a call for further research in this rich and challenging domain as the neuro-complex continues to expand in expected and unexpected, yet equally rich and fascinating, ways. (shrink)