Ordinary coalface knowledge

This book has followed two high-profile examples of pharmacogenetics, unpacking assumptions, beliefs and contexts along the way. I have shown both how to, and how not to, get an example of personalised medicine into clinical practice, and have explored the messy intersection between industry, health service funders and clinicians. This chapter draws together ideas around pharmacogenetics by returning to the three dichotomies introduced in chapter 1: coalface–expectations, knowledge–resistance and ordinary–revolutionary technology.

Having just explored the ordinariness of Herceptin, it is to this dichotomy that I first turn. In both case studies, I have shown how pharmacogenetic tests do not arise out of nowhere, but rather, how they are enmeshed in their technical, social and ethical context and can only be understood in those terms. Whatever the claims of commentators, APOE testing for Alzheimer's pharmacogenetics does raise some of the same ethical issues as ‘ordinary’ susceptibility gene testing. And however revolutionary Herceptin seems when it is discussed on the financial pages, once it enters the clinic it becomes an ordinary cancer treatment, subject to the same institutional stresses and strains, with clinicians' attitudes towards and understating of it shaped by their experience of other, older treatments, for example Tamoxifen. If, when they arrive, pharmacogenetic tests are better thought of as ordinary, as opposed to revolutionary, then this should alert us to the importance of the context within which such tests are used.