Abstract
Over the last decade and a half, Nikolas Rose and Paul Rabinow have arguably held the most influential perspective in the social analysis of contemporary bioscience. They have advocated focusing on the “politics of life itself” and on “biosociality.” Attention should be directed to the new forms of identity, belonging, social relationships, and forms of production enabled by these sciences rather than seeing them as forces for bolstering primordial definitions of identity, ideologies of the status quo, and the exploitation of the less powerful. In a broadly Foucauldian vein, Rose and Rabinow have chosen to emphasize how biomedical discourse is productive, not repressive, and have gone so far as to bracket the issue of “resistance” to power, seemingly because that would presume a coherence to power in the first place.
From the perspective of this movement, Kelly E. Happe’s The Material Gene is a proud throwback. For Happe, biology is ideology; its discursive structure is deeply entangled with, dependent upon, and reinforcing of sexist, racist, and capitalist/classist conceptualizations of social relationships and human potential. Happe provides a detailed analysis of breast and ovarian cancer genomics in the transition from the bench to the clinic. She argues, first, that diagnosis and treatment strategies for ovarian and breast cancer simultaneously reinforce white women’s biological purpose as reproduction while establishing black women’s pregnancies as pathological. A chapter about the expansion of population thinking in cancer research has identified racial disparities as genetically caused, again pathologizing black bodies and disembedding them from racist contexts of living and their possible carcinogenic effects. The last substantive chapter argues that the rise of “environmental cancer genomics” individualizes risk and normalizes carcinogenic pollution and the political-economic context that produces it. Together, these analyses form a rich and complex jeremiad against geneticization.
The main contributions of Happe’s book are empirical and political. She disentangles the meanings and assumptions of breast and ovarian cancer genomics as they relate to epistemology and politics. Readers will gain a deep understanding of these domains of research, especially the contradictions and unwarranted assumptions underwriting scientists’ confidently asserted causal stories. They will be encouraged toward skepticism about the radical treatment strategies—prophylactic mastectomy and oophorectomy—driven by genetic diagnoses. These practices, which reduce women to their organs and reduce disease to genetic malfunction, have “served the institutional interests of surgeons” (p. 71) and scientists. The critique of medical epistemology and overtreatment and the defense of environmental health movements aim to give actors other than scientists epistemic authority that would empower alternate definitions of women’s health and disease and ultimately make “treatment” begin with social and environmental change.
The methodological and theoretical contributions are more ambivalent, however. Happe’s book stands on the shoulders of the critique of biology as an ideological tradition best exemplified by the work of Keller, Gould, Harding, Lewontin, and Nelkin, among others. Her main contribution to it is a deepened critique of geneticization as much more than a publicly circulating set of narratives and justifications but as deeply entwined in the subtle epistemological architecture of research and medical practice. But to the extent that she is making the case for a strong method of discourse analysis, Happe’s work is more problematic.
Happe’s discourse analysis method seeks to understand the political logic of genetics regardless of the intentions, values, or actions of geneticists and their interlocutors. The virtue of this strategy is it allows Happe to stay locked onto, for example, the primacy of hereditarianism even as geneticists purport to reject determinism and study gene-environment interactionism. But it has several disadvantages.
One is distortion of the historical record. This is especially apparent in Happe’s discussion of eugenics. She is right to argue that the legacy of eugenics cannot be contained as a relic of genetics’ early history. But her discussion conflates eugenics with “the idea that certain groups of people should be institutionalized, sterilized, or prohibited from immigrating to the United States” (p. 26), and though she acknowledges a debate between “reform” and “mainline” or “negative” eugenicists, she equates them all to the same right-wing, gene-centric, society-dismissing logic. But the historical record shows the precise debate among geneticists and post-1930s eugenicists was the relative priorities of social reform and eugenic policy, the value of hetero- and homozygosity, and the effects of nuclear-fallout-induced radiation (and thus the dangers of the nuclear state). The lack of a discussion of eugenics as a debate about the proliferation of “good” and “bad” genes muddles her later analysis of BRCA tests, which she labels as embodying a eugenic logic. If the response to BRCA tests is oophorectomy, then perhaps so; but if it is to encourage young and multiple pregnancies (which Happe explains reduces cancer risk), then the trend will be precisely dysgenic in that more BRCA mutations will persist in the gene pool.
A similar reduction of complexity occurs in the discussion of gene-environment interaction research into cancer-inducing pollution exposure. Happe argues that at the level of discourse the new “interactionism” is largely a Trojan horse for a gene-centric view of population health, and it normalizes the polluted world by individualizing and geneticizing “disease risk.” But as Sara Shostak (2013) has shown, this issue is not a hidden logic of genetic research, but rather the central dilemma that animates public health geneticists in this domain. They struggle to balance the pragmatism of genetics with the politics of environmental activism, are ambivalent about how genetics transforms authority and resources in their domain, and battle each other about the relationship between the heart of the science and the best way to improve health. To assert that the discursive logic of genetics determines the possibilities of this debate ignores or dismisses the complexity and institutional embeddedness of these professionals’ struggles, while asserting a totalizing and fatalistic politics of biogenetic knowledge.
Throughout, Happe prefers certain scientific alternatives to mainstream genetics. She approvingly cites scientific critics of cancer genetics, social and environmental epidemiologists, environmental activist science, anti-racist geneticists, and developmentalist alternatives to genetic determinism. But given the discourse method, what is the basis of this approval? Are these approved discourses less political, less determined, less inscribed by pernicious social logics, or perhaps inscribed with politically preferable logics? A limitation of Happe’s discourse method is that it makes alternatives difficult to account for and begs the warrant for her preferences. It makes it difficult to see continuities between genetics and its alternatives or how possibilities might be cultivated for breaking with or shifting ideology within genetics.
Misgivings about Happe’s approach to discourse should not eclipse appreciation of her considerable achievements. She has offered a detailed and nuanced analysis of sexist, racist, and pro-capitalism inscriptions in breast and ovarian cancer genetics. She is right to reassert the merits of the ideology-critique tradition and to challenge the overly sanguine, almost anti-critical implications of Rose and Rabinow’s version of biosociality. Her calls are well taken for a “biosociality without genes” animated by exposing the ideological underpinnings of current genetics. Even advanced undergraduates would find Happe’s book hard going, but graduate students and researchers at the intersection of science studies, medical sociology, and feminist, anti-racist, and Marxist theory will find much of benefit here.