“Epigenetics” and “neoliberalism” are eye-catching buzzwords in (typically separate) academic niches. However, to many outside the academy, the two tongue-twisters are nebulous and their everyday relevance ill-defined.
Charles Dupras joins the conversation on Bioethics Forum to say more about an article, “Epigenetics in the Neoliberal ‘Regime of Truth,’” that he co-wrote with Vardit Ravitsky in the January - February issue of the Hastings Center Report. I asked Dupras to explain what we gain from the biopolitical perspective they offer on the translation of epigenetic knowledge. Dupras is a PhD candidate in bioethics at the University of Montreal. Ravitsky teaches in the bioethics program at the University of Montreal and directs the Ethics and Health Branch of the Center for Research in Ethics.
Epigenetics refers to molecular mechanisms that influence the expression of genes, sometimes activating genes and sometimes silencing them. Part of what’s fascinating about these mechanisms is that they can occur in response to social and environmental factors. But they can also be heritable: a gene silenced in a parent may remain silenced in the person’s child. For this reason, epigenetics bridges the gap between individuals’ genetics and their environment.
“Epigenetics could provide the missing molecular evidence of the importance of using public policy to reduce the incidence and prevalence of common diseases,” Dupras and Ravitsky write. However, they caution against the risk that a “clinical translation” will garner more attention and public resources than a “policy translation” of epigenetic knowledge.
Epigenetics has the potential to mobilize political will toward remedying social inequities resulting in common public health problems, but Dupras and Ravitsky worry about two sociological trends that might impede the policy translation of epigenetics: molecularization and biomedicalization.
As personalized medicine has gained more traction, knowledge about health risks and health has increasingly been talked about in terms of individual genetic susceptibility (molecularization) and precise clinical interventions (biomedicalization). Can this shift in perspective directed at the individual impede the translation of epigenetic knowledge into public health strategies? Dupras and Ravitsky are interested in how this scientific knowledge gets translated in a “neoliberal” biopolitical context. Taking a leaf from medical anthropologist Margaret Lock, Dupras explains that they wrote this article to caution against a return to biological reductionism with epigenetics.
Q: What do you consider to be the most important ideas and arguments in your article?
There is scientific evidence of how social disparities and harmful environments impact health, but scientific evidence is not the only factor. To develop and adopt wise policies, we also need political will and social engagement.
There are many pressures on our politicians. They want to do the right thing, to listen to evidence, but they also want to be (re)elected. This creates a reality where political will can be influenced by what we call the “biopolitical context,” by broader social trends. That’s why we claim that the biopolitical landscape can influence what public policies are adopted.
In the U.S., as well as elsewhere in the world, there is a strong emphasis today on personalized or precision medicine. This results from a biopolitical context that favors individual and technological solutions to health problems. There is also an emerging acknowledgement of social determinants of health and the importance of the environment. So, these two trends can create a tension when it comes to choosing how to implement new scientific knowledge. Our main point in this piece is that we should acknowledge the socio-political context and not be completely seduced by one paradigm, but rather find a good balance and translate new knowledge in socially responsible ways.
Q: When you write about the future of epigenetics, you seem to be creating a relationship of opposition between “clinical translation” and “policy translation.” Are these two forms of knowledge translation really oppositional, or are they complementary?
They are complementary approaches. One is more preventative–more upstream. The other, like emergency medicine, is also necessary, but it is downstream. It is about solving problems that have already occurred. So they are complementary across time.
They are also complementary because one addresses the population and the other tackles the individual. Policy translations reflect how we use epidemiological data to implement public health strategies. Clinical translations reflect how we want our doctors to care for individual patients.
In our article, we advocate for a balance between these two approaches. We suggest that in our current biopolitical context we are probably heading too much in the individualized biomedical direction and not enough toward population-level and preventive strategies.
Q: I wonder if your paper overstates the influence of “molecularization” on Western biopolitics. You caution against the dangers of internalizing problems that have a much larger scope, and you argue that this kind of myopia might lead us to disregard some of the most important issues of our time, like social justice, biodiversity, and the protection of ecosystems. But in the U.S. social determinants of health, environmentalism, and social justice are ideas enjoying immense popularity. Are you saying that epigenetics represents a novel threat to the gains that have been made toward recognizing the social determinants of health?
Yes, precisely. We are concerned that epigenetics may create an even stronger emphasis on individual interventions–to the detriment of social ones–if only its clinical translation resonates with the current biopolitical context.
We agree with anthropologist Jörg Niewöhner and sociologist Hannah Landecker that there is something new about the kind of “molecularization” that epigenetics is bringing to the table. In comparison with genetics, epigenetics allows us to bridge the internal body with the external environment. It is a kind of molecularization that opens our eyes to that bridge and most importantly to the influence of the social environment on health. In another article in the journal Bioethics, we argued that, at first glance, epigenetics is indeed a convincing way to promote the collective management of social determinants of health. However, in this article we are asking further: is this really going to happen? We want to explore the possible sociopolitical and economic barriers to such a translation of epigenetics.
Epigenetics changes the vocabulary of discussions about complex issues such as the protection of ecosystems and social justice. We can be discussing the external environment and then shift the discussion toward molecules and what happens inside the body. It’s a shift in what we look at and what we value as important. We need to be aware of that.
Q: “Neoliberal” has become a buzzword in particular academic disciplines, particularly the social sciences and philosophy, but its ubiquity makes me skeptical of its utility. Why is “neoliberal” a helpful descriptive concept in conversations about how epigenetic knowledge might get translated?
We had long discussions about how we were going to name this “regime of truth” (to use Foucault’s term), because it was not self-evident. We are trying to get at the interplay between the influence of society on science and the influence of science on society. We describe four “pathways of thinking”: internalization, isolation, commodification, and technologization. These are all clinical features of epigenetics. But we tried to connect them with broader social trends, with political agendas.
We thought that the term “neoliberalism” best reflects these four processes. It accounts for the focus on the individual and the fact that we can commodify and then commercialize the epigenome. These focuses – on the internalized and the isolated – fit patterns emerging from liberal individualism and economic liberalism.
In short, we wanted to explore why the clinical translation is so dominant in our societies, why clinical approaches are being pushed forward more than the public health ones.
Q: What do you mean when you say “regime of truth,” and why is it important for understanding how epigenetic knowledge gets translated?
We used the concept as a framework (as suggested by sociologist Thomas Lemke) to help us identify what kind of knowledge is perceived as convincing in contemporary societies. Is it, for instance, social theories? Epidemiological data? Molecular mechanistic explanations? In other words, is there a category of scientific evidence that weighs more than others, and, therefore, has more influence on collective/political decision-making? We suggest that molecular-level arguments have this special power in today’s society. We use the term neoliberal regime of truth to name the biopolitical context in which molecular-scale arguments acquire this special power.
Q: Do your observations about neoliberal pressures on the translation of epigenetic knowledge make you pessimistic about the future?
As opposed to being pessimistic, we are critical of a possible future. We can’t predict how epigenetics will be used. But it’s important to remember that social movements are not monolithic and rarely go in one single direction. There is usually tension and dialogue between various actors.
In the recent past, neoliberal forces have influenced the market economy, and this had a variety of social and political outcomes. In this article we caution about the impact these forces might have on how we choose to implement the very promising tools epigenetics research is giving us. We want to put environmental concerns and the reduction of socioeconomic disparities on the table, because they are really important.
Epigenetics is a perfect case study for knowledge translation because it sort of sits between the policy and the clinical approaches. We present these two complementary ways of translating knowledge to show that what determines which road we will take is not just scientific evidence, but also social trends and political will.
Chelsea Jack is a project manager and research assistant at The Hastings Center. This is the first post in a series of conversations with authors of articles in the Hastings Center Report in which they expand upon topical issues of public interest.