, Volume 5, Issue 4, pp 440–466

BRCA patients in Cuba, Greece and Germany: Comparative perspectives on public health, the state and the partial reproduction of ‘neoliberal’ subjects

  • Sahra Gibbon
  • Eirini Kampriani
  • Andrea zur Nieden
Original Article


The relationship among genetic technologies, biosocial identity and patient subjectivity has been the focus of an increasing range of social science literature. Examining mainly European and North American contexts this work has demonstrated the variable configurations of genetic knowledge-practices and the diverse implications for at-risk individuals and populations. This article brings together ethnographic research on genomic medicine, public health and breast cancer in Cuba, Greece and Germany. Although each case study addresses different publics/patients, institutional settings and risk-related practices, they all critically examine ‘neoliberal’ subjectivity and BRCA patienthood, at the intersection of political rationalities, medical discourses, social conditions and moral codes. In the Cuban case, cultural articulations of inherited and other embodied risks relating to breast cancer are analysed in relation to state provision of ‘community genetics’, and the shifting dynamics of public health in response to global social processes. The Greek case explores how culturally embedded values, notions of inherited risk and care inform or are re-articulated through institutional practices and ambivalent subject positions, at the meeting point between individualised medicine, religious philanthropy and the particularities of public health. In the German context, diverging patient subjectivities are examined against the background of prevailing social discourses and institutionalised risk management practices that promote proactive individuality. Drawing on deconstructive and feminist analyses, these case studies reveal how normative ‘neoliberal’ patient subjects are only ‘partially reproduced’ in situated contexts, neither stable nor homogeneous, as different actors and publics variously articulate, embrace or engage with transnational as well as culturally embedded discourses and health practices.


BRCA patienthood neoliberal subjectivity Cuba Greece Germany 


  1. d'Agincourt-Canning, L. (2001) Experiences of genetic risk: Disclosure and the gendering of responsibility. Bioethics 15: 231–247.CrossRefGoogle Scholar
  2. Andaya, E. (2009) The gift of health: Socialist medical practice and shifting material and moral economies in post-soviet Cuba. Medical Anthropology Quarterly 23: 357–374.CrossRefGoogle Scholar
  3. Bharadwaj, A. (2006) Sacred conceptions: Clinical theodicies, uncertain science and technologies of procreation in India. Culture Medicine and Psychiatry Special Issue: Sacred Conceptions: Religion and the Global Practice of IVF 30: 451–465.Google Scholar
  4. Brotherton, S. (2005) Macroeconomic change and the biopolitics of health. Journal of Latin American Anthropology 10: 339–369.CrossRefGoogle Scholar
  5. Brotherton, S. (2008) We have to think like capitalists but continue being socialists: Medicalised subjectivities, emergent capital and socialist entrepreneurs in post-soviet Cuba. American Ethnologist 35: 259–274.CrossRefGoogle Scholar
  6. Butler, J. (1993) Bodies that Matter: On the Discursive Limits of ‘Sex’. New York, London: Routledge.Google Scholar
  7. Butler, J. (1997) The Psychic Life of Power: Theories in Subjection. Stanford, CA: Stanford University Press.Google Scholar
  8. Butler, J. (1999 [1990]) Gender Trouble. New York and London: Routledge.Google Scholar
  9. Derrida, J. (1982 [1968]) Margins of Philosophy, Translated by A. Bass. Chicago, IL: University of Chicago Press.Google Scholar
  10. Derrida, J. (2005 [2003]) Rogues: Two Essays on Reason, Translated by P.A. Brault and M. Naas. Stanford, CA: Stanford University Press.Google Scholar
  11. Eckstein, S. (1994) Back From the Future: Cuba under Castro. Princeton, NJ: Princeton University Press.Google Scholar
  12. Feinsilver, J. (1993) Healing the Masses: Cuban Politics at Home and Abroad. Berkeley, CA: University of California Press.Google Scholar
  13. Finkler, K. (2000) Experiencing the New Genetics: Family and Kinship on the Medical Frontier. Philadelphia, PA: University of Pennsylvania Press.CrossRefGoogle Scholar
  14. Finkler, K. (2003) Illusions of controlling the future: Risk and genetic inheritance. Anthropology & Medicine 10: 52–70.CrossRefGoogle Scholar
  15. Foster, C.G. et al. (2002) Predictive testing for BRCA1/2: Attributes, risk perception and management in a multi-centre clinical cohort. British Journal of Cancer 86: 1209–1216.CrossRefGoogle Scholar
  16. Franklin, S. and Roberts, C. (2006) Born and Made: An Ethnography of Preimplantation Diagnosis. Princeton: Princeton University Press.CrossRefGoogle Scholar
  17. Gammeltoft, T. (2007) Prenatal diagnosis in postwar Vietnam: Power, subjectivity, and citizenship. American Anthropologist 109: 153–163.CrossRefGoogle Scholar
  18. Gammeltoft, T. (2008) Sonography and sociality: Obstetrical ultrasound imaging in urban Vietnam. Medical Anthropology Quarterly 21: 133–153.CrossRefGoogle Scholar
  19. Georges, E. (2008) Bodies of Knowledge: The Medicalization of Reproduction in Greece. Nashville, TN: Vanderbilt University Press.Google Scholar
  20. Gibbon, S. (2007) Breast Cancer Genes and the Gendering of Knowledge: Science and Citizenship in the Cultural Context of the ‘New’ Genetics. London: Palgrave Macmillan.CrossRefGoogle Scholar
  21. Gibbon, S. (2009) Genomics as public health? Community genetics and the challenge of personalised medicine in Cuba. Anthropology and Medicine Special Issue: Biomedical Technology and Health Inequities in the Global North and South 16: 131–147.CrossRefGoogle Scholar
  22. Gibbon, S. (forthcoming 2011) La herencia, family medicine and the (dis)continuities of genomics as revolutionary health care. Social Science and Medicine.Google Scholar
  23. Gibbon, S. and Novas, C. (eds.) (2008) Biosocialities, Genetics and the Social Sciences: Making Biologies and Identities. London: Routledge.Google Scholar
  24. Gottweis, H. (2009) Biopolitics in Asia. New Genetics and Society 28: 201–204.CrossRefGoogle Scholar
  25. Greenhalgh, S. (2009) The Chinese biopolitical: Facing the 20th century. New Genetics and Society 28: 223–229.CrossRefGoogle Scholar
  26. Hallowell, N. (1999) Doing the right thing: Genetic risk and responsibility. Sociology of Health & Illness 21: 597–621.CrossRefGoogle Scholar
  27. Hallowell, N. (2006) Varieties of suffering: Living with the risk of ovarian cancer. Health Risk & Society 8: 9–26.CrossRefGoogle Scholar
  28. Hopwood, P. (2005) Psychosocial aspects of risk communication and mutation testing in familial breast-ovarian cancer. Current Opinion in Oncology 17: 340–344.CrossRefGoogle Scholar
  29. Ioannidou, E. and Galanakis, E. (2008) O prosfatos kodikas iatrikis deontologias, i enimerosi tou asthenous me kakoitheia ke i emploki tis ellinikis oikogeneias [The recent code of medical deontology, the cancer patient informing process and the involvement of the Greek family]. Archives of Hellenic Medicine 25: 224–230, (in Greek).Google Scholar
  30. Jasanoff, S. (2006) States of Knowledge: Science and the Co-production of the Social Order. London: Routlege.Google Scholar
  31. Kampriani, E. (2009) Between religious philanthropy and individualized medicine: Situating inherited breast cancer in Greece. Biomedical Technology and Health Inequities in the Global North and South, Anthropology & Medicine Special Issue 16: 165–178.Google Scholar
  32. Karakasidou, A. (2007) I viopolitiki tou karkinou: empeiria, metaforikes ennoies kai i exousia tis exeidikevmenis gnosis [The biopolitics of cancer: Experience, social metaphor and authoritative knowledge]. Archaiologia & Technes 105: 55–62, (in Greek).Google Scholar
  33. Karakasidou, A. (2008) The elusive subversion of order: Cancer in modern Crete, Greece. In: J. McMullin and D. Weiner (eds.) Confronting Cancer: Metaphors, Advocacy and Anthropology. Santa Fe, NM: School for Advanced Research Press, pp. 83–102.Google Scholar
  34. Kelle, U. and Kluge, S. (1999) Vom Einzelfall zum Typus [From Case to Type]. Opladen, Germany: Leske & Budrich, (in German).CrossRefGoogle Scholar
  35. Kerr, A. (2003) Rights and responsibilities in the new genetics era. Critical Social Policy 23: 208–226.CrossRefGoogle Scholar
  36. Klawiter, M. (2008) The Biopolitics of Breast Cancer: Changing Cultures of Disease and Activism. Minneapolis, London: University of Minnesota Press.Google Scholar
  37. Konrad, M. (2005) Narrating the New Predictive Genetics: Ethics, Ethnography and Science. Cambridge: Cambridge University Press, UK.CrossRefGoogle Scholar
  38. Lemke, T. (2000) Die Regierung der Risiken: Von der Eugenik zur genetischen Gouvernementalität. [The government of risks: From eugenics to genetic governmentality.]. In: U. Bröckling, T. Lemke and S. Krassmann (eds.) Gouvernementalität der Gegenwart. Studien zur Ökonomisierung des Sozialen. Frankfurt am Main, Germany: Suhrkamp, pp. 227–264, (in German).Google Scholar
  39. Lock, M., Young, A. and Cambrosio, A. (2000) New Medical Technologies: Intersections of Inquiry. Cambridge: Cambridge University Press, UK.CrossRefGoogle Scholar
  40. Löwy, I. and Gaudillière, J.P. (2008) Localizing the global: Testing for hereditary risks of breast cancer. Science, Technology & Human Values 33: 299–325.CrossRefGoogle Scholar
  41. Lupton, D. (1996) Food, the Body and the Self. London: Sage Publications.Google Scholar
  42. Luhmann, N. (1990) Risiko und Gefahr [Risk and danger]. In: N. Luhmann (ed.) Aufsätze zur Theorie der Gesellschaft. Opladen, Germany: Westdeutscher Verlag, pp. 126–162, (in German).Google Scholar
  43. Malaby, Th.M. (2002) Odds and ends: Risk, mortality and the politics of contingency. Culture Medicine & Psychiatry 26: 283–312.CrossRefGoogle Scholar
  44. McMullin, J. and Weiner, D. (eds.) (2008) Confronting Cancer: Metaphors, Advocacy and Anthropology. Santa Fe, NM: School for Advanced Research Press.Google Scholar
  45. Morris, R.C. (2007) Legacies of Derrida. Annual Review of Anthropology 36: 355–389.CrossRefGoogle Scholar
  46. Nayeri, K. (1995) The Cuban health care system and factors currently undermining it. Journal of Community Health 20: 321–335.CrossRefGoogle Scholar
  47. zur Nieden, A. (2005) Wie werde ich zum Subjekt meiner Gene? [How do I become subject of my genes?]. In: NGBK (ed.) Put on your blue genes. BioTech-Kunst und die Verheißungen der Biotechnologie. Berlin, Germany: NGBK Neue Gesellschaft für Bildende Kunst, pp. 101–110, (in German).Google Scholar
  48. zur Nieden, A. (2007) If there is a risk inside of me, I am the first person who should know about it’. Images of ‘genetic risks’ as anticipation of the future. In: R. Heil, A. Kaminsky, M. Stippak, A. Unger and M. Ziegler (eds.) Tensions and Convergences: Technological and Aesthetic (trans)Formations of Society. Bielefeld, Germany: Transcript, pp. 163–172.Google Scholar
  49. zur Nieden, A. (2008) Zum Subjekt der Gene werden: Subjektivierungsweisen im Zeichen der Genetisierung von Brustkrebs [Becoming subject of the genes: Ways of subjectification in the age of geneticisation of breast cancer]. Dissertation Freiburg i. Br. (in German, unpublished).Google Scholar
  50. zur Nieden, A. (2009) Die Verkörperung des genetischen Risikos: Gentests für Brust- und Eierstockkrebs aus der Sicht von, Betroffenen’ [The embodiment of genetic risk: Genetic testing for breast and ovarian cancer from the perspective of ‘affected’ women]. In: S. Dungs, U. Gerber and E. Mührel (eds.) Biotechnologie in Kontexten der Sozial- und Gesundheitsberufe. Professionelle Praxen – Disziplinäre Nachbarschaften – Gesellschaftliche Leitbilder. Frankfurt a. M., Germany: Peter Lang Verlag, pp. 83–98, (in German).Google Scholar
  51. zur Nieden, A. (forthcoming 2010) The embodiment of genetic risk: Women's experiences of genetic testing for breast cancer susceptibility mutations. In: A. Bammé, G. Getzinger and B. Wieser (eds.) Yearbook 2009 of the Institute for Advanced Studies on Science Technology and Society. Wien, Germany: Profil.Google Scholar
  52. Novas, C. and Rose, N. (2000) Genetic risk and the birth of the somatic individual. Economy and Society 29: 485–513.CrossRefGoogle Scholar
  53. Ong, A. (2006) Neoliberalism as Exception: Mutations in Citizenship and Sovereignty. Durham, NC: Duke University Press.CrossRefGoogle Scholar
  54. Palfner, S. (2009) Gen-Passagen. Molekularbiologische und medizinische Praktiken im Umgang mit Brustkrebs-Genen. Wissen – Technologie – Diagnostik [Gene-passages: Molecularbiological and medical practices related to breast cancer genes. Knowledge – Technology – Diagnostic.]. Bielefeld, Germany: Transcript, (in German).CrossRefGoogle Scholar
  55. Parthasarathy, S. (2007) Building Genetic Medicine: Breast Cancer, Technology and the Comparative Politics of Health Care. Cambridge, MA: MIT Press.Google Scholar
  56. Paxson, H. (2004) Making Modern Mothers: Ethics and Family Planning in Urban Greece. Berkeley, CA: University of California Press.CrossRefGoogle Scholar
  57. Paxson, H. (2006) Reproduction as spiritual kin work: Orthodoxy, IVF and the moral economy of motherhood in Greece. Culture Medicine and Psychiatry, Special issue: Sacred Conceptions: Religion and the Global Practice of IVF 30: 481–505.Google Scholar
  58. Petersen, A. (1996) Risk and the regulated self: The discourse of health promotion as politics of uncertainty. Australian and New Zealand Journal of Sociology 32: 44–57.CrossRefGoogle Scholar
  59. Polzer, J. (2000) Genetic testing, citizenship and subjectivity: Implications for women and health. In: F. Miller, L. Weir, R. Mykitiuk, P. Lee, S. Sherwin and S. Tudiver (eds.) The Gender of Genetic Futures: The Canadian Biotechnology Strategy, Women and Health, pp. 55–63, NNEWH Working Paper Series, Toronto, York University.Google Scholar
  60. Prainsack, B. and Siegal, G. (2006) The rise of genetic couplehood? A comparative view of premarital genetic testing. Biosocieties 1: 17–36.CrossRefGoogle Scholar
  61. Press, N., Fishman, J.R. and Koenig, B.A. (2000) Collective fear, individualized risk: The social and cultural context of genetic testing for breast cancer. Nursing Ethics 7: 237–248.CrossRefGoogle Scholar
  62. Rabinow, P. (1996) Artificially and Enlightenment: From Sociobiology to Biosociality. In: Essays in the Anthropology of Reason, pp. 91–111. Princeton: Princeton University Press.Google Scholar
  63. Raman, S. and Tutton, R. (2010) Life, science and biopower. Science, Technology and Human Values 35: 711–734.CrossRefGoogle Scholar
  64. Rapp, R. (1999) Testing Women, Testing the Fetus: The Social Impact of Amniocentesis. New York: Routledge.Google Scholar
  65. Reynolds Whyte, S. (2009) Health identities and subjectivities: The ethnographic challenge. Medical Anthropology Quarterly 23: 6–15.CrossRefGoogle Scholar
  66. Robertson, A. (2000) Embodying risk, embodying political rationality: Women's accounts of risks for breast cancer. Health, Risk and Society 2: 219–235.CrossRefGoogle Scholar
  67. Rosendahl, M. (1997) Inside the Revolution: Everyday Life in Socialist Cuba. Ithaca, NY: Cornell University Press.Google Scholar
  68. Rowley, E. (2007) On doing ‘being ordinary’: Women's accounts of BRCA testing and maternal responsibility. New Genetics & Society 26: 241–250.CrossRefGoogle Scholar
  69. Scott, S., Prior, L., Wood, F. and Gray, J. (2005) Repositioning the patient: The implications of being ‘at risk. Social Science & Medicine 60: 1869–1879.CrossRefGoogle Scholar
  70. Seremetakis, N. (2001) Toxic beauties: Medicine, information and body consumption in transnational Europe. Social Text 19: 115–129.CrossRefGoogle Scholar
  71. Sleeboom-Faulkner, M. (ed.) (2009) Human Genetic Biobanks in Asia: Politics of Trust and Scientific Advancement. London: Routledge.Google Scholar
  72. Sleeboom-Faulkner, M. (2010) The Frameworks of Choice: Predictive and Genetic Testing in Asia, Amsterdam: Amsterdam University Press.CrossRefGoogle Scholar
  73. Spiegel, J. and Yassi, A. (2004) Lessons from the margins of globalization: Appreciating the Cuban health paradox. Journal of Public Health Policy 25: 85–110.CrossRefGoogle Scholar
  74. Strathern, M. (2004 [1991]) Partial Connections. Lanham, MD: AltaMira Press, (updated edition).Google Scholar
  75. Thorsteinsdóttir, H., Sáenz, T., Quach, U., Daar, A.S. and Singer, P. (2004) Cuba – Innovation through synergy. Nature Biotechnology 22, Suppl: OC 19–24.Google Scholar
  76. Trakas, D. (2007) Iatriki sti syghroni Ellada [Medicine in modern Greece]. Archaiologia & Tehnes 105: 6–10.Google Scholar
  77. Wahlberg, A. (2009) Bodies and populations: Life optimization in Vietnam. New Genetics and Society 28: 241–251.CrossRefGoogle Scholar
  78. Wöllmann, T. (2007) Andrologie – Wie die Medizin die Männer, entdeckt’ [Andrology – How medicine ‘discovers’ the male]. In: A. Dinges (ed.) Männlichkeit und Gesundheit im historischen Wandel ca. 1800 – ca. 2000. Stuttgart, Germany: Franz Steiner, pp. 87–104, (in German).Google Scholar

Copyright information

© The London School of Economics and Political Science 2010

Authors and Affiliations

  • Sahra Gibbon
    • 1
  • Eirini Kampriani
    • 1
  • Andrea zur Nieden
    • 2
  1. 1.Department of AnthropologyUniversity College LondonLondonUK
  2. 2.Institut für Geschichte der Medizin, Heinrich-Heine-Universität DüsseldorfDüsseldorfGermany

Personalised recommendations