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Paper short abstract

This paper explores how molecular markers of biological difference can ‘solidify’ and acquire new meaning when translated into administrative classifications that delineate access to costly precision technologies and pose challenges to solidary healthcare financing

Paper long abstract

Long celebrated as a scientific frontier, precision medicine now gives rise to complex negotiations of limit-setting in healthcare. This paper explores a particular aspect of these negotiations: the co-production of disease classification and economic concerns. Since the 1980s, molecular markers of disease have reconfigured diagnostic criteria, and generated novel markets for diagnostic assays and targeted therapies. Driven by future imaginaries (Fujimura 2003) of reduced overtreatment (and overspending), these precision technologies come, however, with high costs for already constrained healthcare systems. Drawing on collaborative ethnographic research on the introduction of precision medicine in Denmark since 2017, we trace negotiations about how to delineate the use of costly precision technologies across the fields of inherited eye disease, spinal muscular atrophy, lung- and blood cancer, and diabetes care. In particular, we attend to the interplay of clinical and administrative meaning-making in the delineation of treatment eligible populations and the issues of in- and exclusion it raises in a publicly funded healthcare system founded on principles of universalism and equal access. Drawing upon classical STS-debates on boundary-work (Gieryn 1983, 2007) and the reification of facts (Latour & Woolgar 1979), we demonstrate how cell counts, genetic tests, and cut-off points, used as fluid markers in laboratory and clinical settings, tend to ‘harden’ when translated into administrative classifications. In this process of ‘solidification’, molecular markers acquire new meaning as they come to demarcate limits to publicly funded healthcare and pose challenges to solidarity.

Boundary-work; Denmark; Healthcare; Limit-setting; Precision medicine; Rationing; Solidarity; Solidification