Sexy Tech and Snake Oil: The Affective Attraction and Vulnerability of Precision Medicine

Such collective sentiments were not limited to adjudications of value or the worthiness of particular bodies as the subjects of precision; they also animated the quest for precision, the pursuit of cure and the trajectories these set in motion. As a number of oncologists explained, the project of precision has inspired new ways of thinking and new modes of treatment:

TRAINEE ONCOLOGIST #3: The paradigm’s kind of shifting ... I mean, yeah, I think that’s the big, evolving thing for us ... I think more and more, even as a trainee, we’re starting to think like that, ‘What’s the underlying biology and how can we target this tumour in a different way?’ Because, I guess, chemotherapy is scattergun, isn’t it? And now we have this sexy new tech where we can understand so much more about these tumours, and then we have drags as well. So it’s really changed how we think, from a treatment point of view.

While precision and its associated ‘sexy tech’ might represent a new scientific paradigm, in oncology there is another set of political and economic dimensions that are increasingly driving innovation and shaping the practice of cancer care: the profit motives of pharmaceutical and biotech companies. While the flows of financial capital through pharmaceutical research and development no doubt influence how oncology is currently practiced, this happens in ways that are not always straightforward, nor entirely divorced from various affective desires of clinicians. Talking about the role of private industry in oncology, one clinician put it the following way:

ONCOLOGIST #6: It’s nice for us, from a science perspective ... That’s helping generate the science. It’s driving that ... But again, I think it comes back to that those companies - as much as they’re doing the science, they’re there to make money. And they don’t say that, but you know their secondary aim is to help human beings. I’m sure their principal aim is to make money.

The same entanglement of collective sentiment and financial markets often leaves patients vulnerable to the logics of cure-at-any-cost that are so pervasive in our cultural milieu. As one oncologist explained:

ONCOLOGIST #4: I think cancer is uniquely primed, because you have people who are desperate with a disease ... It’s ripe for metaphor and for desperation and for the selling of-

ONCOLOGIST #1: Snake oil.

ONCOLOGIST #4: - purported cures that really have no basis in reality. That’s where we’re at in cancer.

Much of our analysis across the previous chapters has teased out the various social, relational, temporal and normative dimensions that make us ‘primed’ to search for certainty, answers and, ultimately, cures in cancer. Part of this is driven by popular media spins on new discoveries, which fuel patient expectations:

TRAINEE ONCOLOGIST #7: So for example, with immunotherapy, people are aware of immunotherapy through the media and in talking about things, especially lab work at the moment. And they tell you about this trial, ‘I saw it on the news. What’s going on? Can you ...’ And you have to kind of temper their expectations because some of this stuff is literally just run off the bench. It’s very exciting, but experience will tell us that ten years is about the time before it goes into routine clinical practice. And so a lot of the patients have to be managed in their expectations on when these things will be coming out. And still maintaining hope, but being realistic.

Widespread enchantment with precision, alongside its uneven institutionalisation across cancer care in Australia, has led to a situation in which clinical possibilities do not always live up to the expectations that have been created, particularly in the public sphere. Another oncologist spoke similarly of the difficulties presented by media excitement about new technologies and translation of medical knowledge and expertise, and the potential for patient misinformation or confusion:

ONCOLOGIST #4: |We] still get the patients expecting immunotherapy. They’ll still walk in with this article saying, ‘Immunotherapy is the way forward’, and it’s like, ‘Yeah, but that’s the wrong cancer.’

This illustrates the complicated interplay between the affective enchantment with the future of precision care and the clinical realities of day-to-day cancer care. Of course, this is not to say that the two are necessarily distinct - indeed, as the clinicians highlighted in their varied accounts, the two intersect in increasingly inseparable ways. Current clinical practice routinely runs into the hopeful future that precision medicine promises. Yet how they intersect, the vulnerabilities that result and to what end remain important questions that the attraction of therapeutic innovation tends to obscure.

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