TYRANNY OF THE GENE

A history and debunking of the health sciences’ embrace of precision medicine rooted in genetics.

Tabery, a professor of philosophy and health ethics, argues that the role of genetic research in a fundamental transformation of health care in America was not inevitable. In fact, he suggests, its promise of tailored medicine was not even all that revolutionary, and its current achievements are mostly exaggerated. To make his point, the author investigates the Human Genome Project and the scientists involved as they edged out the opposing environmental approach embodied in the National Children’s Study that fought—unsuccessfully—for more than a decade to offer an alternative data set. In an accessible narrative bolstered by prodigious research, Tabery reveals that victory for genomics was less about hard science and more about business interests, media fascination, and political leverage. The author admits his own belief in the superiority of the environmental approach, its attention to the social determinants of health, and its emphasis on prevention. However, Tabery does more to poke holes in the genetic approach than to validate the effectiveness of the environmental one, and comprehensive, detailed backstories are occasionally digressive and detract from the author’s primary argument. Still, even these details and the way they connect various scientific innovations serve to underscore concerns about how biological information is used, how quickly private industry and political interests can undermine the scientific community, and how cavalierly genetic medicine can play with patient expectations. Tabery succeeds in raising a compelling alarm about where things stand and making clear that the current situation could have been much different, all while laying the groundwork for an alternative future that better solves the disparities that personalized medicine has ignored—and, in some cases, exacerbated. The debates will continue, but the author provides a solid resource within that debate.

An engaging, provocative study of a much-hyped aspect of American health care.