People Like You: Genomics in a London breast cancer service
Session type: Oral
NHS England’s choice of the term, personalisation, in its 2016 vision for improving medical outcomes raises critical contextual issues for clinic participants. Are you presenting as an individual patient, a member of a wider category or both at the same time? Singular and plural remain intrinsically connected in medical practice despite widespread reports that genomic personalisation constitutes a new 'me' as opposed to one-size-fits-all 'we' medicine (Donna Dickenson 2016). Drawing on interviews, observation and a range of meetings from 2013-14 in a breast cancer service, I suggest that applications of genomics conform to longstanding practices of sorting ambiguities and uncertainties of address to a you that is both singular and plural. Even so, calibration between different aspects of your situation with breast cancer may be especially provisional given the speed of change in cancer, knowledge, techniques and therapies. 'Me' medicine, using precise techniques of genomic individuation (n of 1), will appear with therapeutic failure in these clinics since, by definition, there are no evidence-based treatment options (that is, no 'we'). Paradoxically, participants may also welcome such situations if they then direct clinical attention to a broader range of needs and preferences, that is, to a personalised care.