Genomics, Obesity and the Struggle over Responsibilities (eBook)

Preface 6
Acknowledgements 7
Contents 8
Contributors 10
About the Authors 11
Part I Introduction 14
1 Challenges of Genomics to Obesity and Traditional Ethics 15
The Problem 15
The Perspective of This Study 18
Plan of the Book 19
References 23
2 Genomics and Obesity from a Pragmatist Point of View 24
Introduction 24
Pragmatism 24
Genomics 25
Obesity 27
Four Trends: Prevention, Individualization, New Risks and Information Overload 29
A Pragmatist View of Genomics and Nutrigenomics 30
Implications for the Pragmatist Study of Genomics and Obesity 32
References 34
Part II Concepts of Genomics and Obesity What Can Genomics Imply for Society?
3 Behaviour, Environment or Body: Three DiscoursesINTbreak on Obesity
Introduction 36
Discourse I: Behaviour Individualizing and Moralizing 37
Discourse II: The Environment Politicising and not Individualizing 41
Discourse III: The Body Individualizing, but not Moralizing 43
Conclusion: The Disruption of the Existing Discourses by Genomics 44
References 46
4 Contesting the Obesity `Epidemic': Elements of a Counter Discourse 48
Introduction 48
Disease, Risk Factor or What? 49
Numbers Games, Financial Stakes and Conflicts of Interest 52
Weighing Up Obesity Research 56
'Fat But Fit' 58
Conclusion 61
References 63
5 Three Main Areas of Concern, Four Trends in Genomics and Existing Deficiencies in Academic Ethics 67
Introduction 67
Obesity, the Phenomenon 67
Three Main Areas of Ethical Concern 69
Health and Food 69
Public and Private Health 70
Personalized Nutrition: Ambiguities 70
How do the Three Areas of Concern Interfere with the Four Trends? 71
Prevention: Food and Health 71
Individualizing in What Sense? 73
Personalized Dietary Recommendations Based on DNA Tests and Biomarkers 73
The Idea of a Gene or Health Passport 74
New Products 75
New Risks and Uncertainties 75
The Dominant, Existing Ethical Vocabulary of Autonomy 77
Ethical Deficiencies of Individualizing Strategies (Moralizing or Not) 78
The Lack of Institutions of Responsibilities 79
Pragmatist Outlook 80
Technology and Ethics 80
The Intrinsic Connection Between Autonomy, Deliberation and Imagination 81
Deliberations 82
Consultation and Public Opinion Making 82
Monitoring and Accountability 82
Conclusion 83
References 83
6 Obesity Genomics: Struggle Over of Responsibilities 85
Introduction 85
Obesity Genomics: Struggle Over of Responsibilities. Obesity as a Problem for Genomics 86
New Responsibilities and New Distribution of Responsibilities 86
Actors and Arguments in the Three Obesity Discourses 87
Discourse I: Behaviour 87
Discourse II: Social Environment 87
Discourse III: Genes 89
Genomics and New Actors 90
Who is Responsible for This Development, and Should Take the Lead? 92
Three Perspectives on Responsibility 93
Causal Theory of Responsibility 93
Role Theory of Responsibility 94
Pragmatist Theory of Responsibility 95
Content and Scope of Responsibility 97
Problems of Diffusion of Responsibility 98
Social Structures in the Soup of Responsibilities 99
Conclusion 100
References 101
Part III Futures, Genetic Testing and Enhancement 103
7 Obesity in 2020: Three Scenarios on Techno-socio-ethical Co-evolution 104
Introduction 104
Method: Trends, Drivers, Key-Elements, Moral Agnosticism 105
Scenario 1: Health As Merit 107
Scenario 2: Corporate Responsibility (The Environment No Cure) 111
Scenario 3: The Liberation of Fun 116
Conclusion 117
References 119
8 Direct-to-Consumer Genetic Testing: How the PromiseINTbreak of a Personalised Approach is Being Squandered
Introduction 120
Genomics' Promises of Personalised Medicine and Nutrition 120
Prelude: The Example of the BRCA Tests of Myriad Genetics 123
'Genes Direct' 126
Configuring the Consumer 130
A Deadly Verdict 133
Conclusion 134
References 135
9 Genomics, Obesity and Enhancement 138
Introduction 138
Health and Aesthetic Perspectives on Obesity 138
What is Enhancement? 139
Four Issues in Enhancement and Obesity 142
Obesity from a Health Perspective/Distributive Justice 142
Obesity from an Aesthetic Perspective/Distributive Justice 145
Obesity from an Aesthetic Perspective/Personal Ethics 147
Obesity from a Health Perspective/Personal Ethics 150
One Step Further: Eugenics? 152
Summary and Conclusions 153
References 154
Part IV Cultural Framing of GenomicsObesity in The Netherlands and Italy 156
10 Obesity and Genomics in the Netherlands 157
Introduction 157
Overview of the Dutch Situation 157
Role of Stakeholders 160
Government 160
Health Policy: Insurance Companies 161
Industry and Retail 161
NGO's 162
Schools 162
Experts on Obesity and Genomics in the Netherlands and the Three Discourses 163
The Three (Plus One) Discourses 163
Response of the Experts 163
The Future of Genomics and Obesity 164
Conclusion 165
References 165
11 Obesity and Genomics in Italy 166
Introduction 166
Overview of the Situation of Obesity in Italy 166
Research on Obesity in Italy 169
Addressing Obesity and Initiatives in Italy 170
Italian Experts' Opinions on Responsibilities and Responses to Obesity 175
Food Education and Involvement 176
Changing Behaviour, No Diet 176
Genomics 178
Conclusion 179
References 180
12 Holland-Italy: A Match Too Far? Comparative Analysis of Italy and The Netherlands on Obesity and Genomics 182
Introduction 182
The Meaning of a Comparative Analysis 183
Obesity in Europe 184
European Dimensions of the Rise in Obesity 187
The Italian Situation 189
The Dutch Situation 189
Comparison Holland Italy 190
Conclusion 191
References 192
Part V Food and Health: Toward a Happy Match of Genomics, Obesity and Values 193
13 Prevention of Obesity and Personalized Nutrition: Public and Private Health 194
Introduction 194
Nutrigenomics as Component of Public Health Programmes 195
Nutrigenomics as Personalised Nutrition 195
Opening Up the Black Box of Nutrigenomics as Personalized Nutrition 196
Four Aspects of Personalized Nutrition 196
Personalized Nutrition as a Hype 197
Public Health and Personalized Nutrition: Two Aspects 197
The Public Meaning of the Relationship Between Food and Drugs 198
Public Value of Personalized Nutrition 199
Making Policies in Times of Social and Scientific Uncertainties 199
Two Ethical Perspectives 200
Discussion of the Two Aspects of the Relationship of Public and Personalized Strategies 202
The Relationship Between Food and Health 202
Public Regulation of Personalized Nutrition 206
Future Prospects 206
Conclusion 207
References 207
14 Expectations and Disappointments of the Human Genome: The Genomics Health Card and Anti Obesity Pills 209
Introduction: A Short History of the Genome 209
An Example: The Emergence and Demise of the Genomics Health Card 211
New Target: Groups? 212
Disillusion? 213
The Rise and Fall of Anti Obesity Pills 214
Conclusion 215
References 215
15 Matching Nutrigenomics, Society and Values 217
Introduction: Ambiguities, Framing and Co-evolution 217
Vicissitudes Determine the Concepts and Vocabularies About Obesity and Genomics 219
Applied Ethics, Technology Assessment and the Vicissitudes of Genomics 220
Applied Ethics 220
Technology Assessment 220
Dealing with Framing Vocabularies and Ambiguities in Deliberative Learning Processes 221
Towards a Happy Match Between Nutrigenomics, Society and Values 223
Nutrigenomics and Fair Representation of Foodstyles 224
Conclusion 225
References 226
Part VI Conclusion 227
16 Conclusion: Beyond Genomics and Obesity 228
Introduction 228
Genomics Going Obese: From Promises to Practices 228
Ethical Issues 231
Genomics and Obesity: Shifting Responsibilities 233
Trends, Hypes, Expectations and Ambivalences of Nutrigenomics 235
Paradoxes of the Current Co-evolution of Nutrigenomics, Society and Values 235
Outlook and Conclusion: Ethical Implications of the Co-evolution of Genomics, Social Order and Values 239
References 241
Name Index 243
Subject Index 247