Paper short abstract:

This paper considers discourses on biomedical translation by discussing the incorporation of genetic diagnostics in European health care. While not explicitly framed in terms of translation, the contextual specificity and stakes of this case provide important insights for positioning translational rhetoric.

Paper long abstract:

The question how to make medical innovations available to patients has been high on science policy agendas in recent years. Under the banner of 'translation', a plethora of epistemic, institutional and regulatory reforms have been proposed to ostensibly smoothen the integration of new diagnostics and treatments in health care. But while this translational imperative is of relatively recent vintage, the problem of access to innovative health care has long presented a formidable challenge to health care policy. In this paper, I therefore interrogate the recent rhetoric around translation by analyzing logics of making innovative medical technologies available that preceded the translational framing. I do so by presenting a comparative analysis of the incorporation of genetic diagnostics in health care delivery arrangements in Germany, the Netherlands and the United Kingdom. I demonstrate how in each of these distinct national contexts, epistemic, regulatory and institutional distinctions intersect in attempts to balance broad public access to medical care with availability of novel procedures. Bringing my observations back to current discourses on translation, I juxtapose the universal and linear assumptions in these discourses with the situated negotiations required for public health care provision. On the one hand, my comparative perspective suggests that such context-specific routines deserve more careful consideration when thinking of translation in biomedicine. At the same time, I propose that present translational rhetoric in many ways builds on the tension between welfare reforms and technological innovation I sketch, raising further questions about distributive justice in the translational enterprise.