Donna Dickenson: Reclaiming Biotechnology for the Common Good

Donna Dickenson, Me Medicine vs. We Medicine

“Under the pressure of corporate interests and neoliberal policies, we’ve lost sight of the idea of the commons in biomedicine—but it has only disappeared temporarily from view. Reclaiming biotechnology for the greater good will involve resurrecting the commons.”—Donna Dickenson

In “Reclaiming Biotechnology for the Common Good,” the final chapter of Me Medicine vs. We Medicine: Reclaiming Biotechnology for the Common Good, Donna Dickenson explores some of the recent efforts to move away from personalized medicine toward processes in which genetic and other medical information is broadly shared and benefits many. Here is an excerpt from the chapter:

The idea of the genome as the common heritage of humanity underpinned the international agreement reached by scientists in the “Bermuda statement,” which declares: “All human genome sequence information from a publicly funded project should be freely available in the public domain.”.. There’s also the 1997 UNESCO Universal Declaration on the Human Genome and Hu­man Rights, which states: “In a symbolic sense, the human genome is the common heritage of humanity . . . [and] in its natural state, shall not give rise to financial gain” (articles 1 and 4). So how did we move from this originally communitarian vision for the new genetic biomedicine to the now-dominant personalized medicine paradigm?

Here in the final sections of the book, I want to introduce a new argument: under the pressure of corporate interests and neoliberal policies, we’ve lost sight of the idea of the commons in biomedicine—but it has only disappeared temporarily from view. Reclaiming biotechnology for the greater good will involve resurrecting the commons. That’s a tall order, I know, but moves are already afoot to give us grounds for optimism. The commons has become a focus of activism, from the Occupy Wall Street movement that was in the me­dia spotlight in 2011 to decisions involving private patenting in the U.S. Su­preme Court.

Governance of the commons has received substantial attention and analy­sis in terms of common property in land and the environment. But the no-property-in-the-body rule in law has limited its applicability to the idea of a common property in the genome or human tissue. An exception can be made for James Boyle’s wide-ranging application of the commons model to “sha­mans [traditional knowledge], software [information technology and the open-access movement] and spleens [human tissue].”

Although some attention has focused on the genome, many other aspects of modern biomedicine could, and I think should, be considered a commons. This is a novel argument, one original to this book. I’ve been interested in the concept of the commons in biomedicine for some time, primarily in terms of commodification of the body. Yet my thinking has moved on through con­sidering the wide range of examples I’ve analyzed in this book. I now see ad­ditional weight and heft in the concept of the commons, extending beyond the genome, although certainly also relevant there.

Take the notion of herd immunity, encountered in the vaccination cases. When between 85 to 95 percent of the population contribute individually by having themselves immunized, they create a commons: population immunity. They needn’t do so out of altruism: as I argued in chapter 6, it’s also the correct and prudent decision for each of them as individuals, provided that the side effects don’t outweigh the probable benefits. Advocates of the free market ought to accept this argument: it actually mirrors the “invisible hand” model espoused by Adam Smith, in which individual economic decisions produce the best outcome for the collective without any external intervention.

This nexus of thousands or millions of personal decisions then creates a common property in population immunity, which also benefits those inca­pable of being vaccinated (neonates and the very elderly). The sum is indeed larger than its component parts, and that sum could be considered a com­mons. Everyone has equal rights to benefit from the intangible commons of population immunity, much as all villagers could claim grazing rights in the traditional land-based commons, but neither commons belongs to any one individual.

Public health affords other examples of a biomedical commons. Life expec­tancy in the nineteenth century was extended through the creation of such a commons in resistance to smallpox, along with another benefi cial commons in clean water and effective sewage, greatly lessening the incidence of cholera and typhus. In modern biomedicine, we can also regard public bodies such as the NIH, medical charities, and governments as having created a form of the commons through the Human Genome Project and other massive public in­vestments in biotechnology.

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