Introduction: Public Health Genomics—Anthropological Interventions in the Quest for Molecular Medicine

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Introduction: Public Health Genomics—Anthropological Interventions in the Quest for Molecular Medicine
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Medical Anthropology Quarterly (MAQ).
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Taussig, Karen-Sue and Sahra Elizabeth Gibbon
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Genomics
Public health
Ethnography
Race
Environment

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We introduce this special issue of Medial Anthropology Quarterly on public health genomics by exploring both the unique contribution of ethnographic sensibility that medical anthropologists bring to the study of genomics and some of the key insights offered by the essays in this collection. As anthropologists, we are concerned with the power dynamics and larger cultural commitments embedded in practices associated with public health. We seek to understand, first, the broad significance of genomics as a cultural object and, second, the social action set into motion as researchers seek to translate genomic knowledge and technology into public health benefits.
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Karen-SueTaussig DepartmentofAnthropology UniversityofMinnesota SahraElizabethGibbon DepartmentofAnthropology UniversityCollege,London Introduction PublicHealthGenomicsAnthropologicalInterventionsintheQuestfor MolecularMedicine Weintroducethisspecialissueof MedialAnthropologyQuarterly onpublichealth genomicsbyexploringboththeuniquecontributionofethnographicsensibility thatmedicalanthropologistsbringtothestudyofgenomicsandsomeofthekey insightsofferedbytheessaysinthiscollection.Asanthropologists,weareconcerned withthepowerdynamicsandlargerculturalcommitmentsembeddedinpractices associatedwithpublichealth.Weseektounderstand,rst,thebroadsignicance ofgenomicsasaculturalobjectand,second,thesocialactionsetintomotionas researchersseektotranslategenomicknowledgeandtechnologyintopublichealth benets. [genomics,publichealth,ethnography,race,environment] Fortoolong,discussionsconcerningtheethical,legal,andsocialimplicationsof genomicshaveabstractedquestionsofpowerandtheproductionofknowledgeout oftheirframesofreferencetofocusonindividualandindividualizingissuessuchas autonomy,choice,consent,and"culturalcompetence."Thoughoftenproductive, suchanalysesareseverelylimited,mostfundamentallybyanimplicitunderstanding ofthesocialassomethingthatissomehowsubsequenttoscience. Thesediscussionshavedevelopedoverthepasttwodecades,decadesthathave beenmarkedbyanexplosionofknowledgeinthelifesciences,particularlyknowledgerelatedtothemappingofthehumangenomeandsubsequenteffortstorealize thegoalofusingthisnewknowledgetoimprovehumanhealth.Intheseefforts, weseetheemergenceofacomplexsocialterraininformation,characterizedby therethinkingofearlierscienticorthodoxiesaboutbiologythat,inturn,have openedupanimaginativespaceforenvisioninganddevelopingnewmedicinesand biotechnologiesthatmightanimatebodiesandextendlifeinnewways. MEDICALANTHROPOLOGYQUARTERLY ,Vol.27,Issue4,pp.471488,ISSN07455194,onlineISSN1548-1387. C 2013TheAuthors.MedicalAnthropologyQuarterlypublished byWileyPeriodicals,Inc.onbehalfofAmericanAnthropologicalAssociation.Allrightsreserved. DOI:10.1111/maq.12055 ThisisanopenaccessarticleunderthetermsoftheCreativeCommonsAttributionLicense, whichpermitsuse,distributionandreproductioninanymedium,providedtheoriginalworkis properlycited. 471

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472 MedicalAnthropologyQuarterly Inthisspace,wendgenomicsshiftingbetweenafocusonlab-basedmapping andtheuptakeofearlyndingsinsuchpracticesasprenataltesting(see,e.g., Inhorn2008;S.Kahn2000;Rapp1999;Rothman1993;Taussig2009)tothehype andhope-lledpromiseofpersonalmedicine(see,e.g.,Borupetal.2006;Brown 2003;Fortun2008;Hedgecoe2004;Rajan2005;Taussig2005,2007)andtoan emergingfocusonpublichealthandthecomplexinteractionsamongepigenetics, epidemiology,infectiousdisease,environmentalexposures,andhumanbiological variation(Landecker2007;Lock2005;Shostak2005;Taussig2005,2007).These interlinkagesarenolongerconnedtoorarisesolelyinthecontextofdeveloped countriesbutareunfoldinginglobalandtransnationalarenaswithoftenuneven, inequitable,andunexpectedconsequences(BharadwajandGlasner2009;Gibbon andReynolds2009;Gottweissetal.2009;Rajan2005). MedicalAnthropologyandPublicHealthGenomics Therelationshipbetweengeneticsandpublichealthis,ofcourse,notinitselfnovel, butithasatroublinghistoryinitspreviousunionineugenicsmovements(Kevles 1995[1985];Lombardo2010;Proctor1988,1995).Inreactiontotheeugenic excessesofthemid-20thcenturyfromtheHolocausttowidespreadmandatory sterilizationprogramsatleastintheUnitedStatesandScandinaviaafterWorld WarII,lifescientistsfocusinginthisareaworkedhardtodisinvestthescienceof geneticswithsuchconnotationsandestablishitasadisciplinefocusedonbasic scienceandondiseaseproblemswithagoalofmedicalapplication(Keller1992). Indeed,therationaleforthemorethan$3billionfundingfortheHumanGenome Project,aswellassubsequentpublicandprivatesupportforgenomicsresearch,has beenthatsuchknowledgewouldpayoffintheformofvaluableinterventionsinto humanhealth,frequentlycouchedintermsofanultimategoalofmedicinetailored toindividualrisksandsusceptibilities.Nevertheless,atensionpersistsbetweena widespreadcommitmenttothisviewofcontemporarygenomics(see,e.g.,Schaefer etal.2009)andrecognitionthateugenicthinkinghashadacontinuousplacein scienceandmedicinerightuptothepresent(Duster1990;Kerr2003;Reardon 2005;Taussigetal.2003). Theculturalanxietiesthathaveaccompaniedtheestablishmentofgeneticsasbig sciencestem,inpart,fromtheon-goingeugenicpossibilitiesthatemergewithsuch knowledge.Withotheranthropologists(e.g.,Fortun2005;Hoeyer2008;Petryna etal.2006;Rapp1999),wecontendthatresponsestosuchanxietiesaretoooften framedinthelanguageofatraditionalbioethics. Althoughwerecognizethatbioethicsisadiverseinternationaleldwitharange ofapproaches,whichinsomeinstancesaimstoincorporatebroadersociopolitical dimensions(see,e.g.,ParkerandBull2009),wendthatwhatwearedescribingas a"traditional"approachseemsmostfrequentlyforegroundedinbioethicscommitteesandinpolicy.Thisbioethicstendstofocusonconcernsforindividual/consumer choicebyemphasizingtheimportanceofinformedconsentwithrespecttoclinical trialresearchortheapplicationofnovelgeneticknowledgeortechnologies.Itis aparticularframingofethicalproblemsthatimplicitlyreducesfearsaboutcontemporarygenomicstodiscreteconcernswithindividualautonomyandchoice withinspecicresearchagendasandclinicalpractices,ratherthanonthemultiple

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Introduction:PublicHealthGenomics 473 specicdimensions,interactions,andprocessesthroughwhichsuchphenomenaare articulatedandpursued.Suchafocustendstoobscurethepowerdynamicsandthe largerculturalcommitmentsembeddedinthisdomainofcontemporarysociallife. Asanthropologists,weareconcernedpreciselywiththeseculturalcommitments andthepracticesthatsimultaneouslyproduceandreinforcethem.Inparticular,we seektounderstand,rst,thebroadsignicanceofgenomicsasaculturalobjectand, second,thesocialactionsetintomotionasresearchersseektotranslategenomic knowledgeandtechnologyintopublichealthbenets. Ahighlyinterdisciplinarygroupofscholarsinawidearrayofnationalcontexts isworkingtounderstandthisemerging"naturalcultural"terrain,denedbythesimultaneousproductionofthebiologicalandthesocial(Haraway2003;Helmreich 2009;Marks2009),inwhichthegrowingandunevenscopeofgenetictechnologies andknowledgesisinformingandinteractingwithdifferentinstitutional,national, andtransnationalarenasofhealthcare.Herewendcontemporaryconcernswith genomicsandpublichealthnowemergingthroughthelensofepigeneticsandacontemporaryconcernwithgeneenvironmentinteractions.Thecomplexandchanging natureofgeneticknowledgeinrelationtoseeminglyoldereldsofinquirysuchas epidemiology,whichnowlinktoandarereframedbywhatappeartobenovel areasofinvestigationsuchasepigeneticsortoxico-genomics,raisesnewchallenges forsocialscienceandcross-disciplinaryinvestigation(seeFortunandFortun2005; Shostak2005). Theessaysinthiscollectionillustratethatmedicalanthropologistsbringatleast threeimportantandintersectingcommitmentstoinvestigatingtheseproblems. First,theyhaveaninterdisciplinaryorientationthatinsiststhat all knowledge includingbiomedicalknowledgeandthescienticknowledgefromwhichitdraws issocialknowledgethatsimultaneouslyrequiresanddemandsadeepunderstanding ofboththescienceandthemedicineinvolvedinaparticularareaofstudy(Young 1982;seealsoLocketal.2000;Martin1987,1994;RappandDisotell2003). Second,likeotheranthropologists,medicalanthropologistsemploywhatDaniel SegalandSylviaYanagisako(2005)nameda"complexclusterofintellectualdispositions"inorientingtheirinvestigations.SegalandYanagisakotracethesedispositionsbacktoBoas'scritiqueofraceandracialscience. 1 Theyincludea"propensity tobesuspiciousinthefaceoftheconvergenceofscienticclaims,ontheonehand, andbothsocialprejudiceandethnocentrism,ontheother"aswellas(echoing Young)"acriticalempiricism"thatseeksto"grapplewith,ratherthantodeny, thedifcultiesraisedbytherecognitionthathumanobservationisalwaysalready socialized"(SegalandYanagisako2005:13).Theyalsomakeanimportantpoint aboutthevalueofcomparison,arguingthatanotherBoasiandispositionanthropologistsbringtotheiranalysesisan"epistemologicalstance"thatrecognizes"there arenoinsignicanthumancases,'meaningthatknowledgeofhumanity'mustbe basedasmuchontheexoticasonthefamiliar"(SegalandYanagisako2005:13). Suchdispositionsarecrucialforunderstandinggenomicsasaculturalobjectin generaland,regardingthefocusofthiscollectioninparticular,forunderstanding howsocialactionissetintomotionineffortstobuildtheknowledgeandpractices ofapublichealthgenomics.Anthropologistsachievethisbyhighlightingtheculturalcommitmentsthatunderlietheseeffortsandbyprovidingcrucialcomparative perspectivesonthechangingnatureofgenomicsasitisemerging.

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474 MedicalAnthropologyQuarterly Third,medicalanthropologistsworkwithacommitmenttone-grainedethnographyandtodevelopingadeepunderstandingoftheworldviewsofthosewith whomwework.AsSusanReynoldsWhytepointsout,ethnographyis"thetest" (2009:10)thatenablestheilluminationoftheeverydayexperiencesofdiversesocialactors.Intheessaysincludedinthiscollection,weseetheseactorsworkingto realizeand/orbenetfrommolecularmedicalknowledgeandtheproductionand applicationofpublichealthgenetics. Totheextentthatanthropologicalworkreectsthesethreecommitments,itcontributesuniqueinsightstotheefforttounderstandthiscomplexsocialeld.Inso doing,thearticlesinthisissueillustrateapathwaypastcurrentpublichealth,bioethical,andsocialsciencepreoccupationwithaddingsocialcontextasthesolutionto understandingthedynamicsorsocialimpactofemerginggenomicknowledge.Instead,theypointtothemultiplespecicdimensions,interactions,andprocesses throughwhichthesocialisneverafterthefactoftechnologicalinnovation.Indeed, wecontendthatsimplyaddingsocialcontextasafterthefactofferstoosimplistic renderingsofcontextandofculture. Asthecontributionstothisspecialissueillustrate,effortstodeveloppublichealth geneticsalsoopenupnewquestionsformedicalanthropologyaboutnatureand culture,citizenship,inequitiesinaccesstoandprovisionofhealthcare,institutional ethics,andtransnationalowsofcapital.Thesephenomena,inturn,offernew conceptualandmethodologicalchallengesforthedisciplineabouthowtoengage with,include,andaddressquestionsofbiology,ofnature,andofthescienticin anevolvingeraofgenomics. Ourinterestintheseissuesprovidedtheimpetusthathasresultedinthiscollection.Theessayswereinitiallydevelopedforasessionweorganizedonpublic healthgenomicsforthe2009meetingsoftheSocietyforMedicalAnthropologyfor whichSusanLindeeandRaynaRappprovidedcommentary. 2 Inadditiontowhat isincludedhere,paperswerepresentedbyKaren-SueTaussig,MargaretSleeboomFaulkner,andMichaelMontoya.PeterFryalsodevelopedapaperbutwasunable totravelfortheconference.Althoughthesearenotincludedhere,wediscusssome ofthesignicantpointsmadeinthepresentations,aswellasotherrelevantresearch, toilluminatethebroadthemesandcross-culturalperspectiveanthropologicalwork inthisareaaddresses. TheCaseofBreastCancerandBRCAGenomics Therearenumerousillustrationsandexampleswherethedemandforinterdisciplinaryengagementandcommunicationbecomesevidentandurgent.Onesuch exampleisprovidedbytherapidlyexpandinganddynamiceldofBRCAgenomics, whichoffersapertinentreminderofthenecessityandchallengeofcross-disciplinary work.Thediscoveryofthetwoso-calledbreastcancergenesinthemid-1990sand theensuinginstitutionalizationofBRCAknowledge-practicesandaccompanying medicaltechniquesforassessinggeneticrisk,includingpredictivegenetictesting,has developedrapidlyinEuro-Americansocieties;atrajectoryofhypeandhopethat hasparalleled(andintersectedwith)thepublicdiscoursesurroundingthehuman genomeprojectinthelate1990s.

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Introduction:PublicHealthGenomics 475 TherapidexpansionoftheeldofBRCAmedicinehas,notsurprisingly,beenan areaofinterestforsocialscientists,withstudiesexaminingpatients'perceptionsof riskandquestionsofidentityforthosecaughtupwiththisnoveleldofhealthcare (Finkler2000;Gibbon2007;Gibbonetal.2010;Gibbonetal.Inpress;Hallowell 1999).Othershaveturnedattentiontotheinstitutionalculturesandpracticesthat surroundtheapplicationofthisnovelmedicalintervention,oftenlinkedtothe specicitiesofpublichealthindifferentculturalcontexts(Bourret2005;L owy andGaudilli ` ere2009;Parthasarathy2007)butalsooftenassociatedwithcultures ofactivism(Gibbon2008)orreligiousandcommunityorganization(Kampriani 2009).AgrowingbodyofworkisalsoexploringthemeaningofBRCAmedicine forspecicpopulations,includingunderservedgroupsintheUnitedStatesand AshkenaziJewishwomen(Mozersky2012;MozerskyandGalen2010). ItalsohasbecomeincreasinglyobviousthattheapplicationofBRCAtestingin clinicalarenasistakingplaceinaterrainofon-goingmedicalandscienticdebate anddiscussionthatisonlyjustbeginningtounderstandthecomplexityofdisease nowrelatedtogenetic,epigenetic,andgeneenvironmentpathways.TherecognitionofthiscomplexitymakesresearchandmedicinelinkedtotheBRCAgenesa highlymobilearenaofscienticinquirythatposescontinuouschallengesformedical application and socialscientistsinterestedinunderstandingtheseresearchtrajectories,theirclinicaldynamics,andtheconsequencesofongoingmedicaluncertainty forpatientidentityandhealthpractice. Newavenuesofmedicalandscienticresearchdemandattentiveandengaged socialscienceinquiry.Thisincludesthedevelopmentoftreatmentinterventions forBRCAcarriersandtheuseofknowledgeabouttheBRCAgenestodevelop treatmentpathwaysforsporadiccancers(Bourretetal.Inpress)aswellasthe growinginterestin"foundermutations"connectedtotheBRCAgenesindifferent nationalorgeographicalarenas. Theselatterresearchinitiativesaredirectlyassociatedwithadiscourseonpublic healthlinkedtothehopeofdevelopingtargetedtreatmentinterventionorcheap testingtechnologythatcanbemademorewidelyavailabletounderservedpopulationsandcommunities.Infact,inthebroaderpost-genomicspaceofbreastcancer nowemerging,thesocialandscienticcomplexityofthedynamicsbetweenBRCA, breastcancer,andpublichealthgenomicsisbecomingapparent.Thisisparticularlysonowthatancestry,race/ethnicity,andinequitiesandethnicdisparitiesin breastcancerincidenceandmortalityhavebeguntoinformand(forsome)provide ajusticationforscienticresearch(see,e.g.,Fejermanetal.2008). TheseshiftingresearchdynamicsaroundtheBRCAgenesillustratethevital importanceandnecessityofmuchclosercollaborationbetweenthenaturaland socialsciences.Asothercommentatorshavealsonoted(e.g.,Lock2005;Lockand Nugyen2010;Montoya2011;RappandDisotell2003),thelifesciencesconstitute anarenathatisproducingbothprofoundchallengesandnovelopportunitiesfor medicalanthropologythatrequireustothinkseriouslyandreexivelyaboutthe meaningofinterdisciplinarity. WhatIsatStake?AnOverview Thearticlesinthisspecialissueaddressthesedifferentyetintersectingissuesatthe heartofeffortstotranslategenomicknowledgeintoclinicallyusefulinterventions

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476 MedicalAnthropologyQuarterly forpublichealththroughtwoprimarythemes:First,howistheinterfacebetween differentaspectsofgenomics(e.g.,epigenetics,epidemiology,humanbiologicalvariation,predictiveandprenatal/neonataltesting)andpublichealthbeingconguredin diversenationalarenas?Howdothestate,institutionalactors,andcitizensbecome positionedinrelationtoemergentgenomicpracticesaimingtodevelopmolecularmedicine?Second,whataretheframeworks(theoreticalandmethodological) foranalysisinmedicalanthropologywhenthebiologicalandthesocialarebeing framedinrelationtogenomicsatthesametimethatepigeneticsandenvironmental factorsarebecomingmorecentraltogeneticscience? Inaddressingtheseissues,theauthorsfocusonawidevarietyofemergingaspects ofgenomicmedicineandpublichealthinterventionsastheserelatetodiversedisease conditionsacrossabroadrangeofinternational/transnationalculturalarenas.These areasincludeCuba,theUnitedStates,theCaribbean,andEurope. Thechangingspaceofgenomic/postgenomicknowledgeandtechnologyasit relatestocommoncomplexconditionssuchasasthmaandbreastcancerprovides onecross-cuttingthemeforthecollection.Ofparticularinteresttoseveralofthe authorsarethewaysthatnewconcernsaboutenvironmentalfactorsarebeingarticulated,performed,andmobilizedinrelationtothe(often)contradictorydemands andconcernsofgenomicsaspublichealth. Thepoliticsof"race"providesasecondtopicalthemethatconnectstheinterests ofanumberofcontributors.Interestcentersonhowraceplaysoutaspartof specicseeminglyolder and ,simultaneously,morenovelpublichealthinterventions inverydifferentnationalarenas,suchasBarbadosandtheUnitedStates,wherethe historicalandsocialmeaningofrace/ethnicity/identityhavebeenverydifferently constituted. Theroleandmeaningof"publics"or"community"and"citizenship"isathird themethatistakenupandaddressedbyanumberoftheauthors.Contributions focusonthewaytheseoftenintersectingideas/conceptsandpracticesbecomeinvoked,enlisted,andcoproducedthroughgenomicinterventionsas"personalized medicine"unfoldsindiversearenasandaseffortsharmonizetheglobalgovernance ofgenomics,oftenthroughethicalnorms,havediverseeffectsonlocalpractice. Environment,Epidemiology,andCommunity Sincetheinceptionofpublichealthasamodernproject,theenvironment,environmentalfactors,andthecontrolofthesehavebeencentralconcernsforthediscipline. Fromsanitationprojectsthatworktopreventtheproliferationofmicrobiallifeto vaccinationcampaignsthatmoderatethebody'sencounterwithhithertodeadly viruses,publichealthhassoughttoensurehumanhealthinrelationtotheenvironment.Sucheffortsfrequentlyoccurasnationalprojectsfocusedonaparticular nation-state,asacomponentofcolonialism,and/orasanaspectofdevelopment (see,e.g.,Latour1983,1988;Nash2007;QuirkeandGaudill ` ere2008;Rosenberg 1976). Environmentalhealthscientistshavediverseandoftenextremelybroadviews abouttheenvironment,includingeverythingfromabody'sexposuretoanearly inniterangeoforganicandsyntheticcompoundstomoreorlesscomplexrenderingsofsocioeconomicfactorssuchasdiet,exercise,education,stress(including thatassociatedwithpovertyanddiscrimination),andsoon(FortunandFortun

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Introduction:PublicHealthGenomics 477 2005;Frickel2004).Conceptualizationoftheenvironmentcanbecomeevenmore complicatedinthecontextofpublichealthgenomics.Forpublichealthgeneticists seekingtounderstandtherelationshipsamonggenesandenvironments,theenvironmentmightalsomeantheenvironmentinsidethenucleusofacell,thecellitself, afetus,auterus,radiationexposures,andsoon. Theessaysinthiscollectiontakeupthequestionofenvironmentindiverseways. Inthepostgenomicera,IanWhitmarshsuggests,conceptualizationsoftheenvironmentarecentraltonewcongurationsofgeneticexpertise,publichealth,and governance.ForWhitmarsh,whofocusesonasthmainBarbados,acountrywith oneofthehighestlevelsofasthmaintheworld,whatpreciselyconstitutestheenvironmentisasiteofcontestationinwhichcommunityhealth,scienticexpertise,and thedangersofmodernizationareatstake.Whitmarshillustratesthat,inBarbados, publichealthpractitionersconcernedwithasthmaincreasinglyarecomingtorely ongenotypingtechnologiesasameansofinterpretinganenvironmentcomprisedof householdallergensthatinteractwithgenesassociatedwithallergicresponse.This approachchallengescommunityunderstandingsofasthmaasaresultofmodernity, relatedtoanenvironmentcharacterizedbyroadwork,dietarychanges,insecticides, andvehicleexhaust.Insodoing,genomicresearchturnsthemeaningofenvironmentfromcausativetobackground,fromdemographictoindividualized. TakingupthequestionofcommunitiesinhispresentationattheSocietyforMedicalAnthropologymeeting,MichaelMontoyaremindedusthatfordecadessocial andbehavioralapproachestohealthresearchhavebeenconcernedabouttheinterconnectionsbetweenenvironmentsandbehavior.Contemporaryeffortstotranslate genomicandotherbiologicalinformationintoclinicallyusefulinterventionsnow areturningtocommunity-basedresearchpractices.Inexaminingthisphenomenon, Montoyaarguesthatcommunityknowledgeisnecessarytounderstandbothillness andbasicbiologicalprocesses.Atthesametime,hesuggeststhatitremainstobe seenwhethertheproblemsintheenvironment,andthoseexperiencedbythehumanswithinit,willdirectknowledgeproductionactivitiesorwillmerelybeused asdatapoints,bloodsamples,ortrialspecimens. Epidemiologyisacorecomponentofcontemporarypublichealthpractices.In heressayfocusingongeneticepidemiology,SusanneBauersuggeststhatwithgenetics,scientistshopedto"openepidemiology'sblackboxbetween[environmental] exposureanddisease.'"EchoingoneofWhitmarsh'spoints,Bauerillustratesthat inthismodeling,whatprecisely"environment"meansisbeingtransformed.Bauer arguesthatinthecontextofgeneticepidemiologytheenvironmenthascometo havefunctionalsignicance.Tograspitseffects,everlargerepidemiologicalstudies arerequired,creatingademandforeverlargerdatasets,therebychangingtheways epidemiologyispracticed. Itispreciselythisconcerntohaveaccesstolargedatasetsincorporatingboth geneticandenvironmentalinformationthathavesetintomotiondiverseeffortsto developbiobanks,atopictowhichwewillreturnbelow.Here,wenotethattheyare akeysiteforeffortsaimedatunderstandingtherelationshipsamonggenesandenvironmentsthatareattheheartofcontemporarypublichealthgenomics.Inworking todevelopthisunderstanding,questionsofpopulation,biologicalvariation,and racealsobecomekeythemes.

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478 MedicalAnthropologyQuarterly Biobankingdoesnotyetgureexplicitlyundertheremitofcommunitygenetics initiativesdescribedbySahraGibboninherexaminationofCubaninterventions inpublichealthgenomics.However,thelocalorganizationofgeneticservicesthat istargetedatthelevelofthefamilyformsthebasisonwhichtheexplicitaimof aligningsocialandbiologicalfactorsmaybeusedtoaddressarangeofgrowing healthproblemssuchasbreastcancer.Aconcernandinterestwithsocialfactors pointstoatensionthatspeakstothebroadergeopoliticaldynamicsinwhichCuba issituated. Ontheonehand,weseeadesiretosituatecommunitygeneticswithinamodernist narrative,wheregrowinginvestmentinanexpandingandcompetitivearenaof biotechnologyandsciencecanaddresscutting-edgeparadigmsofgenomicresearch that,attheveryleast,aimtoincludetheroleoftheenvironmentaspartofa commitmenttoaddressingpublichealthproblems.Ontheotherhand,day-to-day workincommunitygeneticsthataimstoincorporatehealthconcernsandinitiatives intoawiderunderstandingofthesocialcontextofpeople'scollectivelivesactsasan implicitcritiqueofindividualizedapproachestohealthcareinwaysthatquestion themoralmantraofgenomicsaspersonalmedicine. Population,BiologicalVariation,andRace Virtuallybydenition,publichealthhasfocusedonquestionsofpopulationswith regardtohealth,makingvariousformsofpopulationstraticationoneofitsprimary practices.Althoughithaslongbeenrecognizedthatmanyofthehealthdisparities ofconcerntopublichealthpractitionersfallalongraciallines,diverseexplanations forsuchdifferenceshavebeenoffered.Thereisarichhistoryinmedicineofideas aboutdiseasedblackbodies(see,e.g.,Hammonds2002;Reverby2009;Wailoo 2000;Washington2006)orofethnicallyidentiedghettosasspacesofcontagion (Craddock2004). Anothernarrativeaboutraciallystratiedhealthdisparitiesfocusesonthesocial, suggestingthatsocialconditions,includingpoverty,education,andracism,underlie suchphenomena.Yet,asgenomicshasemergedasaparadigmthroughwhichto understandhumanhealth,concernsaboutthesesocialfactorsoftenappeartofadeas researchersfocusongeneticdifferencesthatmaycontributetoaparticulardisease. TroyDuster,forexample,pointstothephenomenonofthehighincidenceof hypertensionamongAfricanAmericans(thoughnotinAfricanslivinginAfrica). Aclassic1991studyofhypertensionpublishedinthe JournaloftheAmerican MedicalAssociation arguedthatstress,notanythingbiologicalorgenetic,wasthe majorfactorcontributingtotheincreasedriskofhypertensionforthispopulation (Klagetal.1991citedinDuster2007).But,asJonathanKahn(2005)hasillustrated, atleastby2002researcherswerebeginningtoarguethatheartfailure,forwhich hypertensionisamajorprecursor,wasadifferentdiseaseinAfricanAmericans rootedinunderlyingbiologicalorgeneticdifferences(see,e.g.,Yancy2002). 3 Ironically,whilethe2000announcementofthecompletionofarstdraftofthe humangenomewassuffusedwiththeideathatracialdifferencescannotbediscerned atthemolecularlevel,numerousscholarshavenotedthatinthepostgenomicerawe areseeingthepowerfulreemergenceofbiologicalconceptionsofraceinmedicine (Braun2002;Duster2005;Fullwiley2007b;Goodman2000;J.Kahn2003,2005;

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Introduction:PublicHealthGenomics 479 Lee2009).Kahnarguesthatweshouldbeconcernedaboutashiftinunderstandings aboutthestraticationofhealthalongraciallinesfromafocusondisparitiestoan emphasisondifferencebothbecausesuchashiftreinscribesraceatthemolecular levelandbecause,insodoing,itmightundermineeffortstoaddresshealthinequities (Fullwiley2007b;Kahn2005). Analyzingtheculturallogicsbehindthe1995emergenceofadiscourseonsickle cellanemiaalongwithblackactivisminBrazil,Fry(2011)remindsusoftheuidityofracialcategoriesacrossdiversecontexts(seealsoFullwiley2007a;Tapper 1999;Trouillot1991).Fry'schapterseekstosolvethepuzzleofwhysicklecell anemiacontinuestobeassociatedwiththeblackbodyalthoughitstransmission asarecessivetraitinaclassicMendelianfashionhasbeenunderstoodsince1949. Fryarguesthatunderstandingsicklecellanemiaasa"naturalsymbol"ofa"black race,"asopposedtoa"whiterace,"helpsusunderstandtheemotionalandpoliticalcommitmentofBrazilianblackactiviststoaracial/ethnicunderstandingofthe conditiondespiteBrazilianscientists'argumentstothecontrary.Hesuggeststhat morethananyoneelse,theseactivistsbelievethatBrazilisasocietyofblacksand whitesbutthattheyhavebeenunableto"convinceenoughbrownsandmulattos tojoincommoncauseinamasspoliticalmovement"(2011:169). AsPeterFryillustrates,itisasituationthatrevealsthewayaveryparticularsociohistoricalcontext,where(intheinuentiallogicofGilbertoFreyre 4 )nationhood tiedtoaBraziliancollectiveidentityas miscegenac ao ormixedraceisbeingchallengedonmultiplefronts.Thatis,itisbeingchallengedbyblackBrazilianactivists whorelyonsicklecellasanaturalsymbolintheirquesttomobilizebroaderidenticationwithablackracialcategoryand,conversely,byhigh-prolegeneticstudies inBrazilthatpromotethenationasconstitutedbyuniquelydifferentindividuals. Thecontributionstothisvolumetakeupissuesofpopulation,humanbiological variation,and/orrace.Inherinvestigationofpublichealthgenomics,SusanneBauer interrogateshow,withepidemiologicaltechniques,moleculardataareconnected topopulationcategoriessuchthatdataongeneticvariationareaddedas"markers ofsusceptibility"toepidemiologicalmodeling.Suchmodelingisintendedtocreate personalizedrecommendationsforhealthpromotionbasedonindividualizedrisk, butBauershowsthatultimatelysuchindividualizedassessmentsarebasedon group-specicriskestimatesthat,whentakentotheclinic,leadtospecicproling practices. Ancestry,admixture,andneoliberalconsumeridentitiesarecentralthemesin SandraLee'sanalysisoftheprocessofracializationinanewdomainincontemporarygeneticpractice:companiessuchasNavigenics,23andMe,anddeCODEme, whichofferdirect-to-consumergenetictests.Heressayis,inpart,astoryofinscribingraceingenesthroughDNAancestrypracticesthatrelyonpopulationsampling understoodthroughtheideaofcontinentalancestry.Inthisframe,samplesfrom aYorubapopulationinNigeriacometobeunderstoodas"African"inspiteof thegreatgeneticdiversityonthecontinent,whilesamplesfromaHanChinese populationinDenvercometosignify"Asian." Lee'sessayoffersawarningaboutjustwhomanyclinicaltranslationofgenomic knowledgemightbenet.Sheillustrateshowthehistoryofpopulationsampling practices,includingthereluctanceofmanyincommunitiesofcolortoparticipate inresearchforavarietyofreasons(e.g.,ahistoryofabuse),shapetheresults

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480 MedicalAnthropologyQuarterly individualscanobtainfromthegeneticteststhesecompaniesoffer.Shenotesthat whencomparingallthetestsandtheirrelevancetoEuropeanversusnon-European populations,itappearsthatover93%areapplicableonlytoEuropeans.Pointingto theimplicationsofthisphenomenonforpublichealth,Leearguesthattheevidence suggeststhatitisunlikelythattheclinicaltranslationofgeneticdatawillhave muchimpactonthehealthdisparitiesthatburdencommunitiesofcolor.Herewe ndapoliticsofinclusion/exclusionaffectingdiversecommunitiesandquestionsof citizenshipineffortstodeveloppublichealthgenomics. Publics,Communities,andCitizenship Concernaboutdevelopingpublichealthgenomicsoccursinagapbetweenthe promisesgenomescientistshavemadesincetheinceptionoftheHumanGenome Projecttocreatedramaticnewinterventionsintohumanhealthanditsfailure,to date,torealizethesepromises(Collins2010).Thenowratherextensiveliteratureon biobankingindicateshoweffortstoclosethisgapdependonaccesstolargedatasets thatlinkgeneticmaterialtofamilyhistories,medicalrecords,andenvironmental exposures.Thisliteraturefocusesourattentiononthespecicsofthepoliticsof personalizedmedicine(Hedgecoe2004;Hoeyer2008;HoeyerandTutton2005; Taussig2005,2007),pointingtoemergingformsofcitizenshipthatturnevery personintoapotentialresearchsubject(Taussig2005,2007)andevenmayobligate themtoparticipateinresearchasadutyofcitizenship(see,e.g.,Schaeferetal.2009). Itisclearthatwhathasbeendescribedasaformof"biologicalcitizenship" isnotuniformbutvariablyandunevenlytakenupacrossdiversesocialcontexts (GibbonandNovas2008;Gibbonetal.2010)inwaysthatcaninvolvethestate inmoreorlessexplicitways(RamanandTutton2009).Sleeboom-Faulkner(In press)describesaChineseefforttodevelopbiobanks,includingoneinTaizhou,in JiangsuProvince,whichhasbeendescribedas"theworld'slargesthumangenetic biobank."Bycreatingandcontrollingaccesstothisvaluableresource,SleeboomFaulknerargues,theChinesestateisabletoestablishChinaasacrucialsiteof scienticcompetitionandcollaboration. Arecentspecialeditionof GeneticsandSociety editedbyHerbertGottweiss (2009)isfocusedonAsiaandillustratestheimportanceofconsideringthecomplexwaysthatneoliberalsubjectivitiesandstateinterventionsinbiopoliticsare oftennecessarycomponentsofdiverseandexpandingareasofgenomicmedicine. Nevertheless,Sleeboom-Faulknerexploreshowrapidlyexpandingeldssuchas biobankingcannotbeunderstoodsimplyintermsofWesternconceptsofneoliberal citizenship.ShesuggeststhatbiobankinginChinatakesplaceinahybridcontext thatincludesdeeplyrootedhistoriesofscienticdeterminism and aglobalarenain whichcompetitionandcollaborationhavebecometheguidingidiomsofthestate's investmentingenomics.Insodoing,shearguesthatthiscomplexsetofdynamics animatesinitiativessuchastheTaiizhoubiobankingprojectwhere,despiteinadequatehealthcare,peoplearepreparedtodonatetheirDNAandtissueascollective membersofa modern Chinesenation.AsSusanGreenahalghpointsout:"The storyofbiopoliticsinthemolecularageismorecomplexandcollectivethanwehad thought"(2009:205).

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Introduction:PublicHealthGenomics 481 Theneglectedroleofthestateinconguringgeneticsaspublichealthisaddressedexplicitlybyanumberofessaysinthiscollection.Mostobviously,thisis exploredbySahraGibboninherarticleonCuba,wherethestatehastraditionallybeenoverdeterminedinanalysisofasocialistsociety.ForGibbon,thelensof inquiryisorientedtoon-the-groundexperiences,practices,andperspectivesof healthprofessionalscaughtupintheemergingeldofCubancommunitygenetics. Exploringhowdeeplyheldcommitmentsarearticulatedinpublicandpersonal narrativesbyorabouthealthprofessionals,Gibbonillustrateshowanethicaland emotionallyinfusedorientationtocollectivehealthcare and areadingofgenetic interventionsasamodern"gendered"vocationinformtheday-to-daypracticesof communitygeneticsandtheinteractionsbetweenhealthprofessionalsandpublics. Sheshowshowitisthesedynamicsthatexplaintheinterestin,andultimatelythe difcultiessurrounding,edglingattemptsbycommunitygeneticpractitionersto addresscomplexadultonsetdiseasessuchasbreastcancer.Aproceduresuchas testingforthetwoBRCAgenes,whichinEuro-Americansocietieshascometoexemplifythesuccessofgenomicsandfuelthehopeofgenomicsaspersonalmedicine, is,inthepracticeanddiscourseofCubancommunitygenetics,"outofplace."With somedifculty,itistransmutedbyhealthprofessionalsintointerventionsthatmore easilyttheparadigmofcollectivepublichealth. Importantly,thisengagementwithgenomicsaspublichealthinwhathasbeen seenasasocialistsocietymakesevidentthatwhatisrequiredisaperspectivein whichthedistinctionsbetweentopdownorbottomup,neoliberalandsocialist, ortraditional/modernarereplacedbyacommitmenttoconsideringtheroleofthe stateaspartofalivedsocialandculturalprocess.Thezonesof"culturalfriction" (Tsing2005)constitutedbytheglobal/local/nationalprocessesthatinformpublic healthgenomicsinsettingssuchasCubaandotherWesterncontextscannoteasily beparsedintosimplisticdualities(seealsoOng2006).Theymust,asthepieces inthiscollectiondemonstrate,themselvesbeexaminedasnecessarilyrelationally producedthroughconcretesocial,political,andhistoricalprocessesthatarealways subjecttounexpectedandunstablearticulationandengagement. Citizenship,however,takesonanentirelydifferentmeaningintheU.S.context. Inherpresentation,Taussigexaminedarangeofeffortstoengagevariouspublicsin whatshecallsgeneticthinkingandpractice.Theseeffortsincludeaprojecttoengage everycitizeninVermontinaconversationaboutgeneticsandethicsinthe1990s,a projecttoeducateNativeAmericancollegeanduniversitystudentsingenetics,and acontemporaryprojecttoconductanationalseriesoftownhallmeetingsabout developinganationalbiobank.Thediversityoftheseeffortsinregardtotheir strategies,thepeopletheyseektoengage,andtheirrenderingofsubjectsinrelation tothestateandtomedicalresearchisstriking.Taussigsuggeststhattherehasbeen ashiftfromanearlierperiodofbottom-upcommunityparticipationtoatop-down modelofengagementinitiatedbytheNationalInstitutesofHealthandanemerging conceptionofparticipationinmedicalresearchasanobligationofcitizenship. Inexaminingtheseissuesfromdifferentregionalandtopicalperspectives,this specialissueisanimportantandtimelycontributiontotheemergingareaofpublic healthgenomics,providinganimportantcross-sectionofresearchthatcanspeak aboutandtothechangingroleanddemandsonmedicalanthropologyconcerned withthepoliticsofpublichealth.Seenthroughthelensofthreekeyarenasof

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482 MedicalAnthropologyQuarterly engagementthatincludesnovelconcernswiththeenvironment,thepoliticsofrace asitplaysoutindifferentcultural/historicalcontexts,andtheroleofpublics, communities,andcitizenship,theessaysillustratethediversityofculturalandsociopoliticalissuesandproblemsraisedbytheconjunctionofgenomicsandpublic health. Suchdevelopmentsconstituteamomentofopportunityandchallengeformedical anthropologythatdemandbothurgentengagementandcriticalreection.Meeting thesemultipledemandswillnotbeeasy,butwecontendthatthesearticlesand similarfutureeffortswillgosomewaytoconstitutingandsustainingthevitality andrelevanceofthedisciplineofmedicalanthropologyinthe21stcentury. Notes 1.ThelinktoBoasshowsthatanthropologyhasdifferentnationalhistories.Thisis particularlythecaseregardinghistoriesofsubdisciplinaryrelations.IntheU.S.context, theBoasiantraditionestablishedanideaofafour-elddisciplinethat,despiteBoas'sown skepticismabouttheframework'sabilitytowithstandincreasingspecializationeveninhis ownday,hasmanagedtobemoreorlesssustainedintheUnitedStates.AsTaussighas articulatedelsewhere,importanttraditionsforthekindofworkdonebyanthropologists examiningthelifesciencescanalsobefoundintheBritishcontext(Taussig2006).Shetraces thesetoEvans-Pritchard's(1937)analysisofrationalityinhisstudyofZandewitchcraft, oracles,andmagicandinW.H.R.Rivers's(1922)articulationoftheimportanceofthe socialinhisunderstandingofrapidpopulationdeclineinMelanesia.Forthepurposesof thiscollection,wepointtothesetraditionsinaskingwhatitmeanstotakebiologyseriously, bothasasetofphenomenainnatureandasasocialpracticeconstitutedasascientic discipline,inlightofnewgenomicknowledgeandtechnologies.Wealsoaskhowcanand howshouldthedemandsofinterdisciplinarityandcriticalengagementbemanaged. 2.Thesemeetings,organizedbyMarciaInhornandEmilyWentzellandheldatYale UniversityinNewHaven,Connecticut,celebratedthe25thanniversaryoftheSocietyfor MedicalAnthropology.Acollectionofthekeynoteaddresseshasrecentlybeenpublished (InhornandWentzell2012).Wearegratefultoallwhoparticipatedinoursessionon publichealthgenomics. 3.BothDuster(2007)andJ.Kahn(2003,2005)speaktothedeeplyawedunderstandingsofraceandbiologythatunderliethesearguments. 4.GilbertoFreyrewasaninuentialBraziliansociologistwho,inthe1930s,introduced theideaofBrazilasa"racialdemocracy"with,heargued,a"mixedrace"societybeing morecohesive,united,andequal. ReferencesCited Bharadwaj,A.,andP.Glasner 2009LocalCells,GlobalScience.TheRiseofEmbryonicStemCellResearchinIndia. London:Routledge. Borup,M.,N.Brown,K.Konrad,andH.vanLente 2006TheSociologyofExpectationsinScienceandTechnology.TechnologyAnalysis &StrategicManagement18:285298. Bourret,P. 2005BRCAPatientsandClinicalCollectives.SocialStudiesofScience35:4168.

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Introduction:PublicHealthGenomics 483 Bourret,P.,P.Keating,andA.Cambrosio InpressFromBRCAtoBRCAness:TalesofTranslationalResearch. In BreastCancer GeneResearchandMedicalPractices;TransnationalPerspectivesintheTimeBRCA. S.Gibbon,G.Joseph,E.Kampriani,J.Mozersky,A.zurNieden,andS.Palfner,eds. ESRCGenomicsNetworkGeneticsandSocietyBookSeries,London:Routledge. Braun,L. 2002Race,Ethnicity,andHealth:CanGeneticsExplainDisparities?Perspectivesin BiologyandMedicine45:159174. Brown,N. 2003HopeAgainstHypeAccountabilityinBiopasts,PresentsandFutures.Science Studies16:321. Collins,F. 2010HastheRevolutionArrived?Nature464:674675. Craddock,S. 2004CityofPlagues:Disease,Poverty,andDevianceinSanFrancisco.Minneapolis: UniversityofMinnesotaPress. Duster,T. 1990BackdoortoEugenics.NewYork:Routledge. 2005RaceandReicationinScience.Science307:10501051. 2007MedicalisationofRace.Lancet369:702704. Evans-Pritchard,E.E. 1937Witchcraft,Oracle,andMagicamongtheAzande.Oxford:Clarendon. FejermanL.,J.E.M.Huntsman,S.Beckamn,K.S.Choudhry,E.Perez-Stabel,E.G. Burchard,andE.Ziv 2008GeneticAncestryandRiskofBreastCanceramongU.S.Latinas.CancerResearch 68:97239728. Finkler,K. 2000ExperiencingtheNewGenetics:FamilyandKinshipontheMedicalFrontier. Philadelphia:UniversityofPennsylvaniaPress. Fortun,M. 2005ForanEthicsofPromising,Or,aFewKindWordsaboutJamesWatson.New GeneticsandSociety24:157173. 2008PromisingGenomics.Berkeley:UniversityofCaliforniaPress. Fortun,M.,andK.Fortun 2005ScienticImaginariesandEthicalPlateausinContemporaryU.S.Toxicology. AmericanAnthropologist107:4354. Frickel,S. 2004ChemicalConsequences:EnvironmentalMutagens,ScientistActivism,andthe RiseofGeneticToxicology.NewBrunswick:RutgersUniversityPress. Fry,P. 2011RememberingorForgettingMendel:SickleCellAnaemiaandRacialPoliticsin Brazil. In RacialIdentities,GeneticAncestryandHealthinSouthAmerica.S.Gibbon, R.VenturaSantos,andM.Sans,eds.Pp.155177.NewYork:PalgraveMacmillan. Fullwilley,D. 2007aRaceandGenetics:AttemptstoDenetheRelationship.BioSocieties2:221 237. 2007bTheMolecularizationofRace:InstitutionalizingRacialDifferenceinPharmacogeneticsPractice.ScienceasCulture16:130. Gibbon,S. 2007BreastCancerGenesandtheGenderingofKnowledge:ScienceandCitizenshipin theCulturalContextofthe"New"Genetics.London:PalgraveMacmillan.

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484 MedicalAnthropologyQuarterly 2008Charity,BreastCancerActivismandtheIconicFigureoftheBRCACarrier. In Biosocialities,GeneticsandtheSocialSciences:MakingBiologiesandIdentities.s. GibbonandC.Novas,eds.Pp.1938.London:Routledge. Gibbon,S.,J.Galen,E.Kampriani,J.Mozersky,A.zurNieden,andS.Palfner,eds. InpressBreastCancerGeneResearchandMedicalPractices:TransnationalPerspectives intheTimeBRCA.ESRCGenomicsNetworkGeneticsandSocietyBookSeries. London:Routledge. Gibbon,S.,E.Kampriani,andA.zurNieden 2010BRCAPatientsinCuba,GreeceandGermany:ComparativePerspectivesonPublic Health,theStateandthePartialReproductionof"Neo-Liberal"Subjects.Biosocieties5:440466. Gibbon,S.,andC.Novas,eds. 2008Introduction.Biosocialities,GeneticsandtheSocialSciences:MakingBiologies andIdentities.London:Routledge. Gibbon,S.,andS.WhyteReynolds,eds. 2009Introduction.Specialissue:"BiomedicalTechnologyandHealthInequities intheGlobalNorthandSouth."AnthropologyandMedicine16:165 178. Goodman,A. 2000WhyGenesDon'tCount(forRacialDifferencesinHealth).AmericanJournalof PublicHealth90:16991702. Gottweiss,H. 2009BioPoliticsinAsia.NewGeneticsandSociety28:201204. Greenhalgh,S. 2009TheChineseBiopolitical:Facingthe20thCentury.NewGeneticsandSociety 28:205229. Hallowell,N. 1999DoingtheRightThing:GeneticRiskandResponsibility.SociologyofHealth& Illness21:597621. Hammonds,E.M. 2002Childhood'sDeadlyScourge:TheCampaigntoControlDiphtheriainNewYork City,18801930.Baltimore:JohnsHopkinsUniversityPress. Haraway,D. 2003FortheLoveofaGoodDog:WebsofActionintheWorldofDogGenetics. In Race,Nature,andthePoliticsofDifference.D.Moore,A.Pandian,andJ.Kosek, eds.Pp.254295.Durham:DukeUniversityPress. Hedgecoe,A. 2004ThePoliticsofPersonalisedMedicinePharmacogeneticsintheClinic. Cambridge:CambridgeUniversityPress. Helmreich,S. 2009AlienOcean.AnthropologicalVoyagesinMicrobialSeas.Berkeley:Universityof CaliforniaPress. Hoeyer,K. 2008EthicsofResearchBiobanking:ACriticalReviewoftheLiterature.Biotechnology andGeneticEngineeringReviews25:429452. Hoeyer,K.,andR.Tutton 2005"EthicsWasHere":StudyingtheLanguage-GamesofEthicsintheCaseofUK Biobank.CriticalPublicHealth15:385397. Inhorn,M.,ed. 2008ReproductiveDisruptions:Gender,TechnologyandBiopoliticsintheNew Millenium.NewYork:BerghahnBooks.

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Introduction:PublicHealthGenomics 485 Inhorn,M.andE.Wentzell 2012MedicalAnthropologyattheIntersections:HistoriesActivisms,andFutures. Durham:DukeUniversityPress. Kahn,J. 2003GettingtheNumbersRight:StatisticalMischiefandRacialProlinginHeart FailureResearch.PerspectivesinBiologyandMedicine46:473483. 2005FromDisparitytoDifference:HowRace-SpecicMedicinesMayUndermine PoliciestoAddressInequalitiesinHealthCare.SouthernCaliforniaInterdisciplinary LawJournal15:105129. Kahn,S.M. 2000ReproducingJews:ACulturalAccountofAssistedConceptioninIsrael.Durham: DukeUniversityPress. Kampriani,E. 2009BetweenReligiousPhilanthropyandIndividualizedMedicine:SituatingInheritedBreastCancerinGreece.Specialissue:"BiomedicalTechnologyandHealth InequitiesintheGlobalNorthandSouth."AnthropologyandMedicine16:165 178. Keller,E.-F. 1992Nature,Nurture,andtheHumanGenomeProject. In TheCodeofCodes.D. KevlesandL.Hood,eds.Pp.281299.Cambridge,MA:HarvardUniversityPress. Kerr,A. 2003RightsandResponsibilitiesintheNewGeneticsEra.CriticalSocialPolicy23:208 226. Kevles,D. 1995[1985]IntheNameofEugenics.Cambridge,MA:HarvardUniversityPress. Klag,M.J.,P.K.Whelton,J.Coresh,C.Grim,andH.Kuller 1991TheAssociationofSkinColorwithBloodPressureinUSBlackswithLowSocioeconomicStatus.JournaloftheAmericanMedicalAssociation265:599602. Landecker,H. 2007CulturingLife:HowCellsBecameTechnologies.Cambridge,MA:HarvardUniversityPress. Latour,B. 1983GiveMeaLaboratoryandIWillRaisetheWorld. In ScienceObserved.K. Knorr-CetinaandM.Mulkay,eds.Pp.141170.London:Sage. 1988ThePasteurizationofFrance.Cambridge,MA:HarvardUniversityPress. Lee,S. 2009PharmacogenomicsandtheChallengeofHealthDisparities.PublicHealth Genomics12:170179. Lock,M. 2005TheEclipseoftheGeneandtheReturnofDivination.CurrentAnthropology 46:S47S70. Lock,M.,andV.-K.Nugyen 2010AnAnthropologyofBiomedicine.Hoboken,NJ:WileyBlackwell. Lock,M.,A.Young,andA.Cambrosio,eds. 2000NewMedicalTechnologies.IntersectionsofInquiry.Cambridge:CambridgeUniversityPress. Lombardo,P. 2010ThreeGenerations,NoImbeciles:Eugenics,theSupremeCourt,and Buckv.Bell Baltimore:TheJohnsHopkinsUniversityPress. L owy,I.,andJ.-P.Gaudilli ` ere 2008LocalizingtheGlobal:TestingforHereditaryRisksofBreastCancer.Science, Technology&HumanValues33:299325.

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486 MedicalAnthropologyQuarterly Marks,J. 2009WhyIAmNotaScientist.Berkeley:UniversityofCaliforniaPress. Martin,E. 1987TheWomanintheBody:ACulturalAnalysisofReproduction.Boston:Beacon. 1994FlexibleBodies:TheRoleofImmunityinAmericanCulturefromtheDaysof PoliototheAgeofAIDS.Boston:Beacon. Montoya,M. 2011MakingtheMexicanDiabetic:Race,Science,andtheGeneticsofInequality. Berkeley:UniversityofCaliforniaPress. Mozersky,J. 2012RiskyGenes:Genetics,BreastCancerandJewishIdentity.London:Routledge. Mozersky,J.,andJ.Galen 2010CaseStudiesintheCo-productionofPopulationsandGenetics:TheMakingof "AtRisk"Populations.Biosocieties4:415439. Nash,L. 2007InescapableEcologies:AHistoryofEnvironment,Disease,andKnowledge. Berkeley:UniversityofCaliforniaPress. Ong,A. 2006NeoliberalismasException:MutationsinCitizenshipandSovereignty.Durham: DukeUniversityPress. Parker,M.,andS.Bull 2009EthicsinCollaborativeGlobalHealthResearchNetworks.ClinicalEthics4:165 168. Parthasarathy,S. 2007BuildingGeneticMedicine.BreastCancer,TechnologyandtheComparativePoliticsofHealthCare.Cambridge,MA:MITPress. Petryna,A.,A.Lakoff,andA.Kleinman,eds. 2006GlobalPharmaceuticals:Ethics,Markets,Practices.Durham:DukeUniversity Press. Proctor,R. 1988RacialHygiene:MedicineundertheNazis.Cambridge,MA:HarvardUniversity Press. 1995TheDestructionof"LivesNotWorthLiving." In DeviantBodies.J.TerryandJ. Urla,eds.Pp.170196.Bloomington:IndianaUniversityPress. Quirke,V.,andJ.-P.Gaudill ` ere 2008TheEraofBiomedicine:Science,Medicine,andPublicHealthinBritainand FranceaftertheSecondWorldWar.MedicalHistory52:441452. Rajan,K.S. 2005Biocapital:TheConstitutionofPostgenomicLife.Durham:DukeUniversityPress. Raman,S.,andR.Tutton 2009Life,ScienceandBiopower.Science,TechnologyandHumanValues.doi: 10.1177/0162243909345838. Rapp,R. 1999TestingWomen,TestingtheFetus:TheSocialImpactofAmniocentesisinAmerica. NewYork:Routledge. Rapp,R.,andT.Disotell 2003TeachingFourFields:GeneTherapyforGeneralAnthropologyGeneralAnthropology9:110. Reardon,J. 2005RacetotheFinish:IdentityandGovernanceinanAgeofGenomics(In-Formation). Princeton:PrincetonUniversityPress.

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Introduction:PublicHealthGenomics 487 Reverby,S. 2009ExaminingTuskegee:TheInfamousSyphilisStudyandItsLegacy.ChapelHill: UniversityofNorthCarolinaPress. Rivers,W.H.R.,ed. 1922EssaysontheDepopulationofMelanesia.Cambridge:CambridgeUniversity Press. Rosenberg,C. 1976NoOtherGods:OnScienceandAmericanSocialThought.Baltimore:Johns HopkinsUniversityPress. Rothman,B.Katz 1993TheTentativePregnanacy:HowAmniocentesisChangestheExperienceof Motherhood.NewYork:W.W.Norton. Schaefer,G.Owen,E.J.Emanuel,andA.Wertheimer 2009TheObligationtoParticipateinBiomedicalResearch.JournaloftheAmerican MedicalAssociation30:6772,doi:10.1001/jama.2009.931. Segal,D.,andS.Yanagisako 2005UnwrappingtheSacredBundle:ReectionsontheDisciplineofAnthropology. Durham:DukeUniversityPress. Shostak,S. 2005TheEmergenceofToxicogenomics:ACaseStudyof"Molecularization."Social StudiesofScience35:367403. Sleeboom-Faulkner,M. InpressCompetitiveAdaptation:BiobankingandBioethicalGovernanceinChina MedicalCity(CMC).EastAsiaJournalforScienceandTechnologyStudies. Tapper,M. 1999IntheBlood:SickleCellAnaemiaandthePoliticsofRace.Philadelphia:University ofPennyslvaniaPress. Taussig,K.-S. 2005TheMolecularRevolutioninMedicine:Promise,Reality,andSocialOrganization. In Complexities:BeyondNature&Nurture.S.McKinnonandS.Silverman,eds. Pp.223247.Chicago:UniversityofChicagoPress. 2006Science/Nature/Culture:AGenealogyoftheAnthropologyoftheLifeSciences. PaperpresentedatthemeetingsoftheSocietyforCulturalAnthropology.Panel onEthnographyand/ofTechnoscience:Genealogies,Objects,Translations.May6, Milwaukee. 2007GeneticsandItsPublics:CraftingGeneticLiteracyandIdentityintheEarly21st Century. In BiomedicineasCulture.R.BurriandJ.Dumit,eds.Pp.191204.New York:Routledge. 2009OrdinaryGenomes:Science,Citizenship,andGeneticIdentities.Durham:Duke UniversityPress. Taussig,K.-S.,R.Rapp,andD.Heath 2003FlexibleEugenics:TechnologiesoftheSelfintheAgeofGenetics. In Genetic Nature/Culture,A.Goodman,D.Heath,andM.S.Lindee,eds.Pp.5876.Berkeley, CA:UniversityofCaliforniaPress. Trouillot,M.-R. 1991AnthropologyandtheSavageSlot:ThePoeticsandPoliticsofOtherness. In RecapturingAnthropology:WorkinginthePresent.R.Fox,ed.Pp.1744.Santa Fe:SchoolofAmericanResearchPress. Tsing,A.L. 2005Friction:AnEthnographyofGlobalConnection.Princeton:PrincetonUniversity Press.

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488 MedicalAnthropologyQuarterly Wailoo,K. 2000DyingintheCityoftheBlues:SickleCellAnemiaandthePoliticsofRaceand Health.ChapelHill:UniversityofNorthCarolinaPress. Washington,H.A. 2006MedicalApartheid:TheDarkHistoryofMedicalExperimentationonBlackAmericansfromColonialTimestothePresent.NewYork:Doubleday. Whyte,S.R. 2009HealthIdentitiesandSubjectivities:TheEthnographicChallenge.MedicalAnthropologyQuarterly23:615. Yancy,C. 2002DisparitiesinBlackAmericans'ResponsestoTherapiesMaySignalDifferent Disease.GenomicsandGeneticsWeeklyJune14. Young,A. 1982TheAnthropologiesofIllnessandSickness.AnnualReviewofAnthropology 11:257285.