Me Medicine Vs. We Medicine: Reclaiming Biotechnology for the Common Good

By Donna Dickenson
New York: Columbia University Press
ISBN 978–0231159746
RRP: £19.95


One of the key buzz phrases surrounding current developments in healthcare is “personalised medicine”. From direct to consumer genetic testing to targeted drug therapies, a medical model has emerged that promises the ability to customise healthcare so that it fits precisely to a patient’s genomic profile. As globalisation has occurred with the growing mobility across frontiers of many factors such as goods and commodities, mobility of information and communications of products and services to people, there has also arisen the need to reassert the personal and to carve out a sense of personal identity. Healthcare and biotechnology is not immune to this it would seem. In her latest book Me Medicine vs. We Medicine: Reclaiming Biotechnology for the Common Good it is within this context Donna Dickenson aims to speak, exploring the economic and political factors which are helping to fuel a Me Medicine phenomenon and how she perceives this paradigm shift will, over time, damage our individual and collective well being.

For Dickenson personalized treatment based on genetic profiling is what we terms as “Me Medicine”. In contrast “We medicine” stands for more “one–size–fits–all” treatments as well as public health procedures such as population vaccinations. At the heart of Dickenson’s argument is that whilst the united pursuit may appear to be towards the personalised, we cannot forsake the common effort and directing time and energy towards clinical treatment of the general population. In characteristically unbiased fashion the author tightly weaves together engaging and lucid narrative, commentary and opinion with astute and sound research.

Time to hit pause
From reading some of Dickenson’s other books, she is certainly one of the best placed people to explore such themes given her dual strengths of academic and activist. With tenacity for detail and thought, coupled with astute comment and opinion, Dickenson has produced a superbly written book which challenges some of the commonly held beliefs about personalized medicine, arguing for the regulation of the biotechnological industry and reclaiming commons benefits of human genome research. Dickenson brings much needed light, as opposed to heat, in the form of ethical, social and political reflection to the arena of personalised medicine.

Within the political arena, the phrase “Time to pause and reflect” has become synonymous with government u–turns and perceived cover ups for ill thought through policy decisions. However Dickenson’s book urges us to pause and reflect on the advances of biotechnology before it is too late. In pausing she calls the reader to reappraise the situation, avoid being dazzled too much by the promises being made and take time to reflect on what is actually achievable and where it could lead to. Far from rejecting all notions of personalised medicine, she calls the reader to intelligently appraise the situation and see what We Medicine can achieve and how it can compliment Me Medicine and together serve the common good.

Make you own mind up
Using the language of Roger Pielke Jnr, from his book “The Honest Broker: Making Sense of Science in Policy and Politics”, in my view Dickenson aims to be an honest broker, acting like a hotel concierge service, offering opinion and advice but urging the reader to make up their own minds. The author’s own views come through but the clear and rather refreshing intention is for the reader to make their own minds up.

Dickenson does not seek to criticise the personalized medicine agenda as being inherently bad and something to be rejected. Well informed research and scientific case studies helps to frame her discussion as to what really is and is likely to be achievable in the future, acknowledging that much of the science is still in its early stages. The promises are yet to be fulfilled and with them may well come unanticipated circumstances.

It is the author’s opinion that there are four key dynamics that are at play which drive the growing belief that personalized medicine is in our best interests. These are a) Threat and contamination, b) Narcissism, c) Corporate interests and political neoliberalism and d) sacredness of personal choice. Helping to create in the mind of the reader something a kin to a matrix, these four dynamics are then discussed in relation to four key technologies: Direct to Consumer (DTC) genetic testing, Pharmacogenetics (tailoring drug treatments to specific genotypes), banking of cord blood for future use and enhancement technologies (physically, cognitively or emotionally). On the issue of banking of cord blood the author returns to an issue she tackles in her earlier book Body Shopping. Offering an updated perspective, she takes the reader through an analysis of private and public umbilical cord blood banking. The clear distinction here concerns whether or not cells from an umbilical cord are stored privately (used by that baby or by his or her family at a later date) or publically where they can be used by anyone in need and who are match for the stored cells. The extent to which pharmaceutical companies engage in aggressive marketing tactics on families to gather the cells to then trade at inflated prices is then explored and discussed.

Dickenson also provides a helpful and thoughtful discussion of enhancement technologies, providing a lucid and illuminating response to the arguments often posited by the likes of Harris and Savulescu on the one hand and Fukuyama and Sandel on the other. Framing her discussion with the “Me–We” distinction seems to bring a fresh articulation and synthesis of the issues here which certainly stood out to this reader.

Reclaiming the commons
The book then concludes with the author offering some direction in terms of how the future might be navigated with some possible solutions to how the “Me–We” dichotomy can be harnessed for the common good. While common property in the context of land and the environment has been discussed previously there is difficulty in applying this principle to the body given the “no property in the body” rule. This common law view implies that there is no property right on tissue which has left the body, presumed to be diseased and to have no commercial value (and something that Dickenson raises and discusses in more detail in her book Body Shopping). Drawing her various lines of argument together in this final chapter Dickenson warns of the tragedy of the anti commons, where property owners enclose the commons and make it their private possession, using legal rights to restrict access to a good that would benefit everyone (p. 197). The author cites the work of James Boyle where he posits that advances in biomedicine and information technology is taking us to the brink of a second enclosure movement, turning the value of the commons to private benefit. A recent example of this would be 23andMe, where a corporate commons has been formed created by labour, cash and bodily material of individuals but which belong solely to a private firm of investors or trading partners.

In relation to this Dickenson proposes that a charitable trust model is developed for biobanks so as to restore some form of control and accountability to those who have contributed to the biobank (p 199). The model would not allow for any ownership rights to be conferred on those who contribute to the bank but it does protect biobank contributors, affording them some form of status as beneficiaries of a personal trust. Critics may argue that this model would deter people from participating, but as Dickenson points out might people be deterred if they perceive their altruism is being exploited by commercial gain?

In conclusion, Dickenson delivers an impassioned “call to arms” to reclaim biotechnology for the common good. Recognising there is a balance to be achieved and not merely a choice of one over the other, Dickenson maps out how we might consider striking this balance before the ‘We’ edges out the ‘Me’.

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