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Abstract
The implications of pharmacogenomic innovations for human difference and technological progress, along with the hopes and risks they bring forth, have been addressed as a major area of tension among scientific, personal, and political interests. This article explores the consequences of such clashing concerns in Japan by drawing on current ideas of postplurality within STS and anthropology. How does the body of the diabetic patient—from (thrifty) genes to fat bellies—become an experimental site of biotechnological and public health innovations in contemporary Japan? What is at stake when these bodies move across different locations and scales in the comparative practices of pharmacogenomics? These are the questions I pursue through an ethnographic presentation of adiponectin, a fat-cell-derived hormone that has attracted considerable attention during the past decade in the study of diabetes. By exploring three planes of the adiponectin research (genetics, epidemiology, and drug discovery), the analysis of this case study suggests that genes and populations, publics and scientists, cardiovascular disease and diabetes are not static objects of medicine but rather interfere with each other in their differences through a series of comparative practices, such as linkage analysis, haplotyping, or clinical trials. Such comparisons across populations, markets, disciplines, and disease entities require and generate a permanent traffic between genetics and epidemiology, highlighting the specific dynamics between these scientific realms. In this new form of medicine, I argue, the prevention of disease aligns illness entities with drug responses in a biopolitical work of differentiation, with significant consequences for traditional methods of social research.
Acknowledgments
Early versions of this article were presented in an international research symposium called “Traveling Comparisons: Ethnographic Reflections on Science and Technology,” held in 2009 at Osaka University, and at the 2010 annual meeting of the Society for the Social Studies of Science in Tokyo. I am grateful to Annelise Riles, Joan Fujimura, Naoki Kasuga, and Yamanaka Hiroshi for their useful comments at these sessions. Thanks also to the Ministry of Education of Japan and the Japanese Society for the Promotion of Science for financing different stages of this research. I am also indebted to Casper Bruun Jensen and Anders Blok, who kept asking me difficult questions about comparison. Finally, I would like to thank Morita Atsuro for the long discussions on postplurality as well as our continued work together.
Notes
1 Diabetes is a major health problem in Japan, affecting more than 5 million people directly. According to a survey conducted by the Ministry of Health, Labor and Welfare in 2006, in the population more than forty years of age, the number of patients with diabetes was estimated at 8.3 million (11.9 percent), totaling over 15 million (21.4 percent) when prediabetics—those with impaired glucose tolerance—were included. A global comparative analysis projected health expenditures for diabetes at $22,150,916 in 2010, making Japan the third biggest market of diabetes after the United States and Germany (CitationZhang et al. 2010). See also CitationYazaki and Kadowaki 2006 for an overview of the health policy and genetic research on diabetes in Japan.
2 For an overview of the anthropology of genetics and race, see CitationAbu Ei-Haj 2007; for an STS-oriented introduction to the production and reception of genomic knowledge, see CitationHedgecoe and Martin 2008. Social scientists have been following the development of the biotechnology industry in Japan. For two different approaches, see the historical account of technological change in CitationCollins 2004 and the sociological explorations of ethical issues in CitationTsuge and Kato 2007; CitationHara Takuji's (2003) economic case studies of pharmaceutical innovation are also strongly influenced by science studies.
3 CitationSheila Jasanoff's (2005) comparative analysis of American, British, and German political responses to biotechnological innovations is rich in theoretical insights. For more specific case studies with a focus on biobanks, see CitationGottweis and Petersen 2008.
4 For a dense exploration into the place of comparison in Strathern's work, see CitationHolbraad and Pedersen 2009.
5 The event was “I to Genomu” (“Medicine and Genome”), the third symposium of the Japanese Association of Medical Sciences, Sapporo Prince Hotel, 6–7 September 2001.
6 All names in the main text have been changed to protect the privacy of informants, except for some public figures (e.g., Nakamura Yusuke) and company names.
7 The plural, of course, would be more appropriate here—genes rather than gene—but this is more than ambiguous in the Japanese language.
8 Much has been written on the thrifty gene. On the expansion and transformation of the concept in epidemiology, see, for example, CitationHales and Barker 1992 and CitationZimmet 2000. For an excellent anthropological overview, see CitationParadies, Montoya, and Fullerton 2007, and also CitationRitenbaugh and Goodby 1989 from a biological anthropology perspective. Its ethical implications have been discussed by Robyn CitationMcDermott (1998), among others. For a Japanese introduction of the concept, see CitationTsuda 2003.
9 It is worth emphasizing, however, that these facts, in the Japanese context, are only very rarely categorized in terms of race—a central issue in Montoya's analysis. The few exceptions are likely to be publications for specific international journals or pharmaceutical research with targets that are also valuable candidates for the North American market.
10 Lodish laboratory (Massachusetts Institute of Technology), Spiegelman laboratory (Harvard University), Osaka University, and Showa University.
11 Nemawashi means to “lay the groundwork [for obtaining one's objective]; maneuver behind-the-scenes” (Kenkyusha's New Japanese-English Dictionary, 5th ed., 2003).
12 The genetic research of complex diseases is a case in point in the lively debates around emerging biosocial formations and historical impetus of the life sciences (CitationRabinow 1999; CitationRose 2007). For case studies, see CitationFujimura 1996 on cancer, CitationLakoff 2005 on bipolar disorder in Argentina, CitationLock et al. 2007 on Alzheimer's disease in North America, and CitationPálsson 2004 on osteoarthritis (joint disease) in Iceland.
13 Adam CitationHedgecoe (2004) described this emerging field extensively from a sociological perspective.
14 The first so-called ethnic drug that was approved on the basis of pharmacogenomic findings in the United States was BiDil, prescribed for heart failure in African American patients (CitationKahn 2008). There are other less successful attempts to tune medications to genetic variation; for an insightful account from the field of psychiatry, see CitationLakoff 2005. See also CitationNinnemann 2012 on the pharmacogenomic understanding of traditional medical knowledge in the case of mental disorders.
15 The cutoff between mutations and polymorphisms is generally considered to be 1 percent.
16 A 2004 article in the magazine Citation Nikkei Baiobijunesu , for instance, reported on his work on adiponectin in a special issue on the potential fields of cooperation between science and business in biomedicine: “Adiponectin, which is secreted from fat tissue, stimulates the oxidation of fatty acids in the liver and muscle. It also appears to have a suppressive effect on the progression of atherosclerosis. It is a hormone that developed countries that struggle with a growing population of obese people need like a shower in the desert. [Kasahara] puts forward four ways to apply the results of his findings in developing new medications [noting that] they all start from the collaboration between industry and university.… The promise that one single biological agent may be related to different tissue-selective patterns will have strong implications for drug discovery attracting considerable attention” (2004).
17 A series of failures of new blockbuster pharmaceuticals to reach broad segments of the population, and the expiration of patents due to the increasing length of clinical trials created a sense of crisis at the beginning of the millennium in the pharmaceutical industry worldwide. A further impetus for change came from the emergence of unpatented and state-supported drug manufacturing in third-world countries and, in Japan, the increasing presence of foreign companies in the domestic market. The growing share of over-the-counter and generic medications, and their active support by the Japanese government, gave way to the fragmentation of this market, creating a new context of drug development abroad and at home as well.
18 Note that adiponectin had not even been discovered at this point, so the mechanism of glitazones was explained without much of our current knowledge about this hormone.
19 “PROactive” stands for “PROspective PioglitAzone Clinical Trial In MacroVascular Events.”
20 In June 2006, a revision to Japan's Health Insurance Act mandated health insurers to provide annual health checkups to all Japanese citizens between forty and seventy-four years of age and to further advise those at risk of metabolic syndrome. The stated goal was to control health care costs by a 25 percent reduction of metabolic syndrome cases between 2008 and 2015. But the implications of the revision of law and related findings published in Japanese and international scientific journals remain unclear (CitationLipphardt and Niewöhner 2007; CitationNango and Saio 2006).
21 It is into this fray that Kasahara has chosen to launch by taking the position of a project leader in the largest study of its kind, the Japan Diabetes Outcome Intervention Trial, which started in 2005.
22 For further case studies about the effects of pharmaceutical marketing on the cultures of medical care in the United States and India, see CitationDumit 2012 and CitationEcks 2012.
23 This position is perhaps not so far from that of Lakoff, who, a few pages later in the same book, turns the former claim into an open-ended question: “If sciences such as epidemiology emerged in the context of regulating the health of collectivities within a territory, how should we understand new forms of knowledge such as audit data with respect to the problem of government?” (2005: 137).