Enacting biosocial complexity: Stress, epigenetic biomarkers and the tools of postgenomics.

This article analyses attempts to enact complexity in postgenomic experimentations using the case of epigenetic research on biomarkers of psychosocial stress. Enacting complexity in this research means dissecting multiple so-called biosocial processes of health differentiation in the face of stressful experiences. To characterize enactments of biosocial complexity, the article develops the concepts of complexity work and complexification. The former emphasizes the social, technical, and material work that goes into the production of mixed biological and social representations of stress in epigenetics. The latter underlines how complexity can be assembled differently across distinct configurations of experimental work. Specifically, complexification can be defined as producing, stabilizing, and normalizing novel experimental systems that are supposed to improve techno-scientific enactments of complexity. In the case of epigenetics, complexification entails a reconfiguration of postgenomic experimental systems in ways that some actors deem 'better' at enacting health as a biosocial process. This study of complexity work and complexification shows that biosocial complexity is hardly a univocal enterprise in epigenetics. Consequently, the article calls for abandoning analysis of these research practices using clear-cut dichotomies of reductionism vs. holism, as well as simplicity vs. complexity. More broadly, the article suggests the relevance of a sociology of complexification for STS approaches to complexity in scientific practices. Complementing the existing focus on complexity as instrumental rhetoric in contemporary sciences, complexification directs analytical attention to the pragmatic opportunities that alternative (biosocial) complexities offer to collective, societal, and political thinking about science in society.

Between the genotype and the phenotype lies the microbiome: symbiosis and the making of 'postgenomic' knowledge.

Emphatic claims of a "microbiome revolution" aside, the study of the gut microbiota and its role in organismal development and evolution is a central feature of so-called postgenomics; namely, a conceptual and/or practical turn in contemporary life sciences, which departs from genetic determinism and reductionism to explore holism, emergentism and complexity in biological knowledge-production. This paper analyses the making of postgenomic knowledge about developmental symbiosis in Drosophila melanogaster by a specific group of microbiome scientists. Drawing from both practical philosophy of science and Science and Technology Studies, the paper documents epistemological questions of artefactuality and representativeness of model organisms as they emerge in the day-to-day labour producing and being produced by the "microbiome revolution." Specifically, the paper builds on all the written and editorial exchanges involved in the troubled publication of a research paper studying the symbiotic role of the microbiota in the flies' development. These written materials permit us to delimit the network of justifications, evidence, standards of knowledge-production, trust in the tools and research designs that make up the conditions of possibility of a postgenomic fact. More than reframing the organism as a radically novel multiplicity of reactive genomes, we conclude, doing postgenomic research on the microbiota and symbiosis means producing a story that deviates from the scripts embedded into the sociotechnical experimental systems of post-Human Genome Project life sciences.

Corrigendum: Translating planetary health principles into sustainable primary care services.

[This corrects the article DOI: 10.3389/fpubh.2022.931212.].

Why epigenetics is (not) a biosocial science and why that matters.

Epigenetic modifications offer compelling evidence of the environmental etiology of complex diseases. Social and biographical conditions, as well as material exposures, all modulate our biology with consequences for risk predispositions and health conditions. Elucidating these complex biosocial loops is one of the main challenges animating epigenetics. Yet, research on the development of epigenetic biomarkers often pulls in a direction that departs from a view of biological determinants of health embedded in their social and material environment. Taking the example of the epigenetics of cardiovascular diseases, this paper illustrates how common understandings of epigenetic biomarkers strongly lean toward considering them as mere targets for molecular intervention, rather than as correlates of a complex biological and social patterning of disease. This reductionism about biosocial dynamics of disease, we argue, hampers the pursuit of the goals epigenetics has given itself (in cardiology and beyond). If epigenetic mechanisms point to the deep socio-environmental embeddedness of our health, we conclude, future designs and methods of this research may require an improved methodological consideration of a biosocial perspective.

Translating Planetary Health Principles Into Sustainable Primary Care Services.

Global anthropogenic environmental degradations such as climate change are increasingly recognized as critical public health issues, on which human beings should urgently act in order to preserve sustainable conditions of living on Earth. "Planetary Health" is a breakthrough concept and emerging research field based on the recognition of the interdependent relationships between living organisms-both human and non-human-and their ecosystems. In that regards, there have been numerous calls by healthcare professionals for a greater recognition and adoption of Planetary Health perspective. At the same time, current Western healthcare systems are facing their limits when it comes to providing affordable, equitable and sustainable healthcare services. Furthermore, while hospital-centrism remains the dominant model of Western health systems, primary care and public health continue to be largely undervalued by policy makers. While healthcare services will have to adapt to the sanitary impacts of environmental degradations, they should also ambition to accompany and accelerate the societal transformations required to re-inscribe the functioning of human societies within planetary boundaries. The entire health system requires profound transformations to achieve this, with obviously a key role for public health. But we argue that the first line of care represented by primary care might also have an important role to play, with its holistic, interdisciplinary, and longitudinal approach to patients, strongly grounded in their living environments and communities. This will require however to redefine the roles, activities and organization of primary care actors to better integrate socio-environmental determinants of health, strengthen interprofessional collaborations, including non-medical collaborations and more generally develop new, environmentally-centered models of care. Furthermore, a planetary health perspective translated in primary care will require the strengthening of synergies between institutions and actors in the field of health and sustainability.

On the traces of the biosocial: Historicizing "plasticity" in contemporary epigenetics.

This paper builds upon historico-epistemological analyses of plasticity across the nineteenth and twentieth centuries to distinguish among uses of this notion in contemporary epigenetics. By digging into this diachronic phase of plasticity thinking, we highlight a series of historically situated understandings and pragmatic dimensions of this notion. Specifically, our analysis describes four distinct phases in plasticity thinking across the nineteenth and twentieth centuries: (1) plasticity as chemical modification of the body by its milieu; (2) plasticity as explanandum for the modifications of life's ontogenetic and phylogenetic substrates; (3) plasticity as mechanistic process in need of distinct explanations in ontogeny and phylogeny; and (4) plasticity as responsive potential to perturbations of a complex genetic system of development. These four versions of plasticity provide, in turn, the opportunity to discern synchronically the uses of this notion in epigenetic biosciences. Fleshing out these historical ramifications animating the present, we argue, highlights a fundamental epistemological disagreement at the basis of the controversies around the definition, scope, and epistemic priorities of epigenetics: how to reconcile the contemporary epistemologies of plasticity that hold epigenetic marks capable of bearing the material impression of the environment with those grounded on a strong view of (epigenetic) plasticity as operating under genetic control? Parallel to this analysis of the epistemic space of plasticity from the nineteenth century onward, we show how these distinct modes of understanding body-environment relationships also constituted conceptual, representational, and experimental resources for understanding the entanglement between life as a biological and socially situated phenomenon. These different traces of biosocial thinking ante litteram, we conclude, provide a blueprint to interrogate today's assumptions, values, (social) ontologies, and political leanings behind similar attempts to interpret the biosocial nexus that links our biology with its material, social, and cultural environments.

Epigenetics: ethics, politics, biosociality.

Background: Epigenetics is a burgeoning field of contemporary biosciences, which has attracted a lot of interest both in biomedical and in social sciences. Sources of data: Unsystematic literature analysis and retrospective mapping of highly cited work (source: Web of Science core collection) in the social sciences and humanities engaging with epigenetics. Areas of agreement: Epigenetics poses no new ethical issue over and above those discussed in relation to genetics. Areas of controversy: However, it encourages a different framing and reflexivity on some of the commonly held categories in the moral uptake of scientific discoveries. Growing points: Epigenetics presents us with normative questions that touch upon privacy, responsibility for individual health and for the well-being of future generations, as well as matters of health justice and equality of opportunities. Areas timely for developing research: Epigenetic thinking could help us adjust and refine the problem frames and categories that inform our ethical and political questions with a complex biosocial description of situations, of persons or actions.

Gendered imaginaries: situating knowledge of epigenetic programming of health.

Our paper explores the value-laden and epistemic resources that scientists working in epigenetics and developmental programming of health and disease (DOHaD) mobilise to produce scientific representations of pregnancy and parenthood, which in turn imagine norms, values, and responsibilities for the protection of future generations. In order to do so, we first describe the place of questions regarding the relative weight of paternal and maternal influences on the health of the offspring in the discursive formalisation of this research in scientific publications. This enables us to identify the mutual constitution of 'prototypes' (i.e. experimental designs, settings, techniques) and 'stereotypes' (i.e. social meanings, beliefs, norms and values) of parental roles in DOHaD and epigenetic biomedical sciences, by means of a specific gendered figuration of paternal influences: the 'father-as-sperm'. Second, and drawing from a set of interviews (N = 15), we describe a tension between this dominant, objectifying molecular discourse and the perspective of individual scientists. The situated perspective of individual researchers provides in fact evidence for a conflictual (moral and epistemic) economy of gendered engagements with parental figurations in DOHaD and epigenetic research, and consequently suggests a more fine-grained, as well as conflictual web of socio-political positioning of this 'knowledge' in its societal circulation.

The European politics of animal experimentation: From Victorian Britain to 'Stop Vivisection'.

This paper identifies a common political struggle behind debates on the validity and permissibility of animal experimentation, through an analysis of two recent European case studies: the Italian implementation of the European Directive 2010/63/EC regulating the use of animals in science, and the recent European Citizens' Initiative (ECI) 'Stop Vivisection'. Drawing from a historical parallel with Victorian antivivisectionism, we highlight important threads in our case studies that mark the often neglected specificities of debates on animal experimentation. From the representation of the sadistic scientist in the XIX century, to his/her claimed capture by vested interests and evasion of public scrutiny in the contemporary cases, we show that animals are not simply the focus of the debate, but also a privileged locus at which much broader issues are being raised about science, its authority, accountability and potential misalignment with public interest. By highlighting this common socio-political conflict underlying public controversies around animal experimentation, our work prompts the exploration of modes of authority and argumentation that, in establishing the usefulness of animals in science, avoid reenacting the traditional divide between epistemic and political fora.

Empowerment in healthcare policy making: three domains of substantive controversy.

This paper distinguishes between the uses of empowerment across different contexts in healthcare policy and health promotion, providing a model for the ethical and political scrutiny of those uses. We argue that the controversies currently engendered by empowerment are better understood by means of a historical distinction between two concepts of empowerment, namely, what we call the radical empowerment approach and the new wave of empowerment. Building on this distinction, we present a research agenda for ethicists and policy makers, highlighting three domains of controversy raised by the new wave of empowerment, namely: (1) the relationship between empowerment and paternalistic interferences on the part of professionals; (2) the evaluative commitment of empowerment strategies to the achievement of health-related goals; and (3) the problems arising from the emphasis on responsibility for health in recent uses of empowerment. Finally, we encourage the explicit theorisation of these moral controversies as a necessary step for the development and implementation of ethically legitimate empowerment processes.

Rethinking medical humanities.

This paper questions different conceptions of Medical Humanities in order to provide a clearer understanding of what they are and why they matter. Building upon former attempts, we defend a conception of Medical Humanities as a humanistic problem-based approach to medicine aiming at influencing its nature and practice. In particular, we discuss three main conceptual issues regarding the overall nature of this discipline: (i) a problem-driven approach to Medical Humanities; (ii) the need for an integration of Medical Humanities into medicine; (iii) the methodological requirements that could render Medical Humanities an effective framework for medical decision-making.

Constructing the Medical Humanities gaze.

In the last few decades genomics has completely reshaped the way in which patients and physicians experience and make sense of illness. In this paper we build upon a real case - namely that of breast cancer genetic testing - in order to point to the shortcomings of the paradigm currently driving healthcare delivery. In particular, we put forward a viable analytical model for the construction of a proper decisional process broadening the scope of medical gaze onto human experience of illness. This model revolves around four main conceptual axes: (i) communicating information; (ii) informing decisions; (iii) respecting narratives; (iv) empowering decision-making. These four kernels, we argue, map precisely onto the main pitfalls of the model presently dealing with genetic testing provision. Medical Humanities, we conclude, ought to play a pivotal role in constructing the environment for competent decision-making, autonomous self-determination and respectful narritivization of one's own life.