Early Careerists at HSS Boston: Andrew J. Hogan November 14, 2013Posted by sandyclaus in Early Career, Profile.
Andrew J. Hogan, “Seeing and (Sometimes) Believing: Managing Uncertainty in Prenatal Diagnosis,” Session F11: Managing Risk and Uncertainty in Postwar Biomedicine, Commonwealth Ballroom B (Concourse Level), Friday, November 22, 9:00 – 11:45 AM
This year at HSS, I am part of a panel that brings together historians of science and medicine to examine the management of risk and uncertainty in postwar biomedicine. Drawn together by common interests in classification, risk management, and institutional protocols – as well as the experiences of individual researchers and patients – historians of science and medicine are now jointly probing the convergence of biological and clinical research. Postwar biomedicine encompasses an incredibly diverse spectrum of research and clinical aims, ranging from answering basic biological questions to improving specific patient outcomes. Through historical analyses of prenatal diagnosis, in vitro fertilization, hemophilia treatments, and breast cancer screening, our panel examines the various tensions that exist in biomedicine, which result from the differing goals and expectations of physicians, patients, and basic biomedical researchers.
My talk focuses on the management of uncertainty in the context of prenatal diagnosis. In 1908, William Bateson famously reminded his fellow geneticists to always “Treasure your exceptions!”: a dictum that remains central to the thinking and practices of genetics research today. During the postwar period however, with the uptake of increasingly high-resolution approaches for examining the human genome, the ‘exceptions’ that geneticists ‘treasure’ have become increasingly synonymous with the uncertain results that many clinicians would prefer to avoid. This is particularly relevant in the continuously growing area of prenatal diagnosis, due to the time-sensitive and socially difficult nature of decisions that prospective parents face.
I came to this topic while conducting interviews with biomedical professionals as part of the research for my dissertation, Chromosomes in the Clinic: The Visual Localization and Analysis of Genetic Disease in the Human Genome. Through these interviews, I sought to better understand how physicians and geneticists develop confidence in the links between visible genetic markers and particular clinical outcomes. My interviews focused on the clinical and laboratory history of specific disorders, diagnostic techniques, and methods of standardization.
In my presentation, I describe various approaches, professional and technological, for managing uncertainty in the clinic. I focus on two recent prenatal diagnostic technologies, chorionic villus sampling and DNA microarray. Each of these procedures regularly produces results of uncertain clinical significance. I show that, while ambiguous results make clinical interpretation and consultation more challenging, providers generally feel confident that they possess the tools and procedures needed to manage this uncertainty. Many biomedical professionals treat the patient anxiety that accompanies uncertain results as an issue to be solved with better communication, rather than ceasing to offer a particular test. Indeed, for some prenatal diagnostic providers, the tendency towards uncertainty actually makes for a better test. My talk explores approaches aimed at balancing the conflicting aims of patient-focused diagnosis and biomedical research.
Andrew J. Hogan is a Lecturer in Science, Technology & Society, in the Department of Engineering & Society at the University of Virginia. Hogan recently completed his Ph.D. in the Department of History and Sociology of Science at the University of Pennsylvania. His research examines the visual cultures of postwar biomedicine, with a focus on the evolving ‘look’ of genetic disease and the human genome.