Entangled local biologies: genetic risk, bodies and inequities in Brazilian cancer genetics

Abstract

Engaging recent social science work examining the truth making claims of science and biomedicine, this paper explores how biology is being localised in Brazilian cancer genetics. It draws from ethnographic fieldwork in urban regions of southern Brazil working with and alongside patients, families and practitioners in cancer genetic clinics. It examines how different sorts of ‘local biologies’ are articulated in the context of research, clinical practice and among implicated patient communities and the way these can ‘recursively’ move across different spheres and scales of social action to extend and transform the meaning of the biological. It shows how the mattering of the biological in Brazilian cancer genetics is fundamentally informed by questions of inequity and care, even while multiple local biologies may obscure rather than reveal the biopolitics of cancer. In an era of epigenetics this raises new opportunities and challenges for anthropological analysis as intervention.

Calibrating cancer risk, uncertainty and environments: Genetics and their contexts in southern Brazil

“…Specialist cancer genetic clinics have appeared in the last 10 years in the wealthier and relatively more economically developed southern part of the country, with the hub of clinical based research operating within mostly public health hospitals, linked to universities and research institutes in urban centres. In Brazil cancer genetics is sustained, but also precariously dependent on, national and transnational research collaborations between individual scientists and their research teams, with consequences for which patients are included in research as well as how and what kind of ‘care’ can be offered to them (Gibbon 2017).…”

“…This was particularly evident in the cancer genetics clinics within public health hospitals, such as those that operated in Rio and Porto Alegre, which were more exposed to resource limitations. In this context the uncertainties that quite literally matter for both patients and clinicians, were often about being able to access and offer ‘care’, where a minimum level of attention was more likely to be guaranteed (Gibbon 2017). In this sense the wider financial and institutional instability of public health care provision and cancer genetic research in Brazil, directly shape and themselves help ‘contain’ concerns about how currently unknown contingencies associated with R337h are communicated in the clinic.…”

“…Patient’s explanations of embodied risk in an era of nascent scientific explanations about the epigenetic effects of environments and conditional cancer markers such as R337h would appear to enact a ‘recursively forward’ movement (see Gibbon 2017). That is there are striking parallels between patient narratives of embodied vulnerability and the kind of intergenerational epigenetic reasoning now emerging in certain fields of scientific research, which increasingly illuminate how past traumas have embodied consequences during the life course and for successive generations (Landecker and Panofksy 2013).…”

Diverse bodies: the challenge of new theoretical approaches to medical anthropology

“…Rather than taking a lead from Mol's 'praxiology' as Yates-Doerr and Vogel do, Sahra Gibbon draws on the work of Margaret Lock to consider the different sorts of 'local biologies' that are articulated in Brazilian cancer genetics (Gibbon 2017). Diverse ontologies of 'the body' and 'the biological' are materialised in the clinics she attends and in the accounts she draws out.…”