Guest Post: Epigenetics: Barriers to the translation of scientific knowledge into public policies
Written by Charles Dupras and Vardit Ravitsky
Bioethics Programs, School of Public Health, University of Montreal
Environmental epigenetics is a rising field of scientific research that has been receiving much attention. It explores how exposure to various physical and social environments (e.g. pollution or social adversity) affects gene expression and, eventually, our health. Environmental epigenetics can sometimes explain why some of us carry increased risks of developing specific diseases. It provides activists a powerful vocabulary to promote environmental awareness and social justice. This new vocabulary, which allows us to discuss the consequences of disparities at the molecular level, has been enthusiastically mobilized as an effective way of stimulating political will for promoting public health preventive strategies.
However, this perspective – that we call the ‘policy translation’ of epigenetics – can be contrasted with a ‘clinical translation’ that targets the development of novel biomedical tools to assess epigenetic risks and reverse a detrimental epigenome. In a recent paper published in The Hastings Center Report, we argue that these two approaches are competing for public resources. We suggest that in Western contexts, the clinical translation of epigenetics may end up being prioritized over the policy translation of epigenetics, to the detriment of efforts to promote policy and public health. We highlight four potential barriers or biases that may impede the ‘policy translation’ of epigenetics, with the aim of cautioning against this scenario.
First, our societies operate under the ‘technological imperative’, a culturally engrained preference for technological solutions. In the context of epigenetics, this means that research findings are likely to be translated into biotechnological innovation that targets individual health. For example, in the near future, next generation sequencing technologies might include novel strategies of predictive epigenomics, pharmacoepigenomics, or even epigenetic therapy. Thus, epigenetics studies could be paving the way for additional paths to personalized medicine, or high-tech ‘precision medicine’, targeting individuals’ programmed or inherited biological specificities, rather than large-scale preventive public health initiatives targeting populational vulnerabilities.
Second, an aggressive neoliberal market economy has driven the rapid transformation of the human body and health interventions into marketable products. Increasingly, there is pressure on researchers to translate scientific knowledge into commercial profits. Unlike the social determinants of health, epigenetic biomarkers can be precisely measured, compared and commodified, and techniques that are being developed to reverse them can be patented and profitable. Down the road, the economic advantages of material substrates over complex social phenomena may promote biomedical solutions to societal problems, encouraging knowledge translation that favors lucrative solutions, rather than collective solutions that address systemic threats to population health.
Third, in this neoliberal context, citizens are increasingly isolated from one another and expected to be active healthcare consumers that are aware of and responsible for their specific individual needs. Ironically, epigenetics might contribute to such a trend, as it allows individuals to identify not only immutable genetic mutations, but also ‘epimutations’, some of which they may be able to – and ultimately have a duty to – prevent or ‘correct’ by changing their individual behavior. For example, by downplaying the importance of interactions and systems, a focus on isolated epigenetic variants that would be simply imported from the predominant methodology in the field of genetics could be detrimental to the collective management of social determinants of health.
Fourth, in the current context of liberal individualism, where decisions and responsibilities for health are being transferred from the collectivity to the individual, the clinical translation of epigenetics is likely to be favored over the policy translation, because it transforms ‘external’ determinants of health into ‘internal’ ones. In other words, internalizing within the human body problems that have a much larger scope could lead us to downplay some of the most important societal issues of the new millennium, such as climate changes and social justice. Such challenges are not located inside the human body and have various consequences for human health and well-being.
We must remain aware of the strong sociological trends in which the translation of scientific evidence is embedded. We need to ensure epigenetics knowledge is not only harnessed to strengthen and consolidate the technoscience-oriented curative approach to epigenetic health, but also to support and justify public preventive policies and public health efforts that address socio-economic disparities and protect vulnerable populations from environmental harm.
Finally, we need to be cautious regarding the subtle and potentially adverse effects of using the molecular vocabulary to promote the common good. Contrary to most predictions, such use may reinforce the prevailing idea that molecular explanations of life, health, and diseases are more relevant to policy making than systemic approaches that take a broad view of determinants of health. In biomedicalized Western societies, this may end up bolstering the misguided perception that molecular-level health interventions are more efficient than public policies to improve individual and population health.