Review

Problem genes

Genetics and Society. An introduction
Alison Pilnick
Open University Press, 2002. £16.99

Alison Pilnick has produced a useful textbook for social science students embarking on their thinking about genetics in contemporary society. It covers how genetics has evolved from eugenics, and controversies about the extent to which genes are responsible for complex behaviours.

Having examined applications in genetic testing, screening and gene therapy, pharmacogenetics and cloning, the book takes an excursion into genetically modified foods – uncomfortably slotted between the human genome project and cloning.

In the human field, the book reproduces conventional thinking, with which it is essential for students to grapple. But, like so many other books on the subject, it takes an unjustifiably optimistic view about the potential for genetics in health, and preventive medicine in particular.

This is surprising, given Pilnick’s critique of genetics and intelligence elsewhere in the book. While it seems possible to consider behaviour as complex and not solely explicable through genetics, when it comes to diseases social and environmental dimensions become submerged as medical expertise dominates. For example, Pilnick considers genetic epidemiology ‘less contentious’ than behavioural studies, and suggests that testing for breast cancer genes may help individuals make decisions about prophylaxis such as mastectomy.

But while genetic epidemiology may help us in population-based studies, its use is much more problematic for individuals. Statistically based estimates of risk can mean little for one person unless they are seen in the wider context of, for example, membership of a high-risk family – the same gene can mean very different things in different people. And although the book does remind the reader that environmental factors are as, or more, important than genetic factors, it fails to explore the consequences of this for complex medical disorders and genetic testing.

Pilnick, like so many other sociologists and ethicists, also largely ignores the influence of the pharmaceutical industry in shaping what applications are likely to be made available. Extending genetic testing and promoting preventive care through drugs for the ‘healthy ill’ is a dominant economic interest of this powerful sector.

The diversion of scientific effort from other, non-profit making and possibly more effective approaches to health is an important moral question not only for the developing world but also the developed world. Increasing the market for genetic testing is also in the interests of the biotechnology industry, and it will increasingly work to emphasise genetic causation.

In her ill-placed chapter on GM foods, Pilnick wisely discounts the ‘deficit model’ to explain public unease. Instead, however, she settles on the ‘moral panic’ explanation. Relying on a misconception that concerns are based solely on the findings of one scientist (Puztai), she still manages to convey the sense that public reaction has been irrational and not grounded in substance. Maybe she believes, contrary to the evidence, that people accept newspaper headlines and the accounts of NGOs uncritically.

This book will be useful for lecturers wishing to introduce their students to the subject, but it is not sufficient to illuminate the debate or to help them take it forward intellectually; they will have to look elsewhere. To rely on Pilnick’s book alone would reinforce a model where genes are important in disease but not behaviour, and which fails to explore the socially and economically constructed nature of illness.