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BIOMEDICINE, BIOTECHNOLOGY AND SOCIETY (L3D518 - 20 credits) Module Convenor: Dr Paul Martin
ESSAY TITLE:
HOW CAN EFFECTIVE SOCIAL JUSTICE BE SECURED THROUGH NATIONAL AND INTERNATIONAL GOVERNANCE OF HUMAN BIOTECHNOLOGY
Spring 2010 STUDENT ID: 4102892 Word Count: 4879
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Table of Contents Introduction
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Justice In Human Biotechnology
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Biotechnology and Equality of Opportunity
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Social Justice: Wealth and Welfare Balance
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Governance To Secure Global Justice Role of state government in multi-stakeholder partnership
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Biotechnological Global Justice: Governance without Government 13 Conclusion
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References
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Introduction The study of biotechnology, biomedicine and society demands a multidisciplinary approach to understanding the social context of life sciences, biomedicine and biotechnology. Biotechnology is a wide subject to cover. Therefore, this paper limits its scope to human biotechnology, the political economy aspects of bioeconomy, and how they relate to social justice from a political science point of view. The main question this essay is going to center its discussion is on how to secure social justice through governance of human biotechnology at national and international level? For that purpose, this paper intends to focus on governance mechanisms at national and international level, stressing on the role of state government at national level; and in the case that legal force at international level is absent, global social accountability must have linkages with other punishment mechanisms such as trade restrictions to be effective policing mechanism. This paper will begin by exploring relations between biotechnology, health and social justice. The discussion will then progress to an evaluation of the current governance practices and why governance at national level is not the most effective. Then followed by a description of potential answers to challenges for international governance mechanism in human biotechnology.
Justice In Human Biotechnology The promise of biotechnological revolution is to make lives better: lifespan extension and life quality enhancement at incredible speed and intensity. Although highly contentious (Nightingale and Martin, 2004), the faith in biotechnology is based on the belief that diseases can be cured, future generation have better lives, AIDS in Africa solved, and so forth. Even though definition of fulfilling lives vary across time and society, knowledge
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BBS / Spring 2010/ (ID: 4102892) about how the human body works is valuable in ensuring that people will be able to live fulfilling lives. David Shenk in his interview with The Guardian stated, “our genes influence our lives. But equally our lives influence our genes.” (McKie, 2010: http:// www.guardian.co.uk). The universal value now is that there is a biological problem to be solved by science and technology, and that it is possible to modify genetic makeup of living things to solve these problems (Wright, 1994). Biotechnology and Equality of Opportunity Unfairness comes from limited accessibility of treatments (that are capable of providing biological advantage such as IGM) only to specific groups of people, because one group can afford resources that are beyond universal distribution mechanism (i.e. NHS) and the other cannot. The immediate outlook of human biotechnology is the engineering of superior humans. Not just normal humans. For example Inheritable Genetic Modification (IGM) allow parents to avoid passing genetic diseases, enhancing the child’s opportunity to have preferable qualities (healthier, more intelligent, more attractive, and so on), therefore securing the child’s future opportunities in life. Putting this into a bigger picture, hypothetically states will have the ability to improve its population via eugenics. More so if states encourage choices; for example by offering social, medical and/or economic arrangements (Kerr, 2004: 71). I find this as the immediate challenge to social justice in health. Health care ought to even out inequities as health allows individuals to secure his/her ends (Hale and Hale, 2009:356), not create inequalities. Improved knowledge on human conditions enable us to prevent, diagnose, treat and cure diseases. But the same knowledge could also result in unintended consequences such as bioterrorism, emergence of new diseases due to mutations, and misuse of information. This is the reason why
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BBS / Spring 2010/ (ID: 4102892) securing social justice becomes crucial as social justice seeks to protect fair equality and opportunity through ways of assigning rights and duties (Rawls, 1999:4). Miller (2005:3-20) elaborated that the core values that constitute social justice are equal citizenship (equal set of basic rights and means to exercise them effectively), social minimum of resources, equality of opportunity, and fair distribution of resources. As Daniels (2008:14) defines, injustice is failure “to protect opportunity or capability of people to function as free and equal citizens”. Here I highlight that technologies capable of creating biological superiority will generate feeling of deprivation in the majority, while the minority who have access will “seek to protect their advantage” (Beyleveld and Pattinson, 2004:68). Creation of the biological elites and the strive to be “normal” perpetuates social inequalities, exclusion and injustice. At international level, the creation of superior population create global disparities. Looking at the above, I agree with Daniels et al (2000) that justice and inequality become determinants of health. Inequalities between groups become unjust when socially controlled factors such as availability of treatment are not fairly distributed. The more understanding modern studies provide on human conditions, the stronger the people believe in genetic determinism and higher are the hopes to change lives through alteration of the genes. Adopting eugenicist position that selects genetic traits and eliminate undesirable genes leads to segregation of people into normal and abnormal groups. Allowing genetic information go unregulated could lead to misuse and denial of access (e.g. insurance companies refusing coverage based on risk). Injustice in biotechnology therefore comes from: 1) Certain group’s inability to access treatment, 2) unfair practices at national and international level that can cause harm (e.g. bioterrorism, high priced drugs), and 3) failure to setup regulatory frameworks that protect equality of opportunity.
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BBS / Spring 2010/ (ID: 4102892) The challenge is not in defining what justice means in biotechnology, but to put principles of justice into practice. Which brings us to questions on principles of distribution: universal or selective? entitlement or discretion? led by demands or rationing? and most importantly, who decides? Any argument for the principles of distribution (i.e. utilitarian, libertarian, and so forth) agree on the same idea that allocation of biotechnology advances is subject to control, and resources are either scarce or costly. Therefore governance of biotechnology must take place in order to achieve a good balance between science advancement, protection and promotion of social justice, and market/economic development. Social Justice: Wealth and Welfare Balance Achieving the right balance between policy and investment to promote health requires short and long term strategies, managing different actors with different interests. A welfare state has the responsibility to improve health and reduce inequalities through prevention and treatment of diseases. Charities and advocacy groups seek to reduce costs and cater to smaller patient groups or individuals. Private sector seeks to build revenue sources (Corrigan and Tutton, 2009: 304). All these interests show that biotechnology is not just about scientific advances to solve biological problems. There is a broad social and economic condition that influence the distribution and use of biotechnological product. There are different options to achieve social justice in biotechnology. The first option is to base social justice on the extension of economic opportunity, focusing on redistribution of opportunities (i.e. facilitating competitiveness through constant innovative capabilities of people and companies). The second option is fair distribution of whatever goods and services are available (i.e. universal provision of health, education, and so on).
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BBS / Spring 2010/ (ID: 4102892) When a country follows the first option, it will focus on industrial investment by public and private sectors, research and development of science and technology, increasing future productivity in the economy. But taking this path does not automatically lead to social justice in terms of redistribution. Human biotechnology is a vibrant industry. In the US, bioscience industry employs 1.3 million people in 50 states in 2008. 35% of the sector is in medical laboratories (research, testing), 24% in drugs and pharmaceutical, and 33% in medical devices and equipment. Only 8% of the sector is dedicated to agricultural feedstock and chemicals (BIO, 2009). The caveat of a market-orientated society, however, is the difficulty to impose legal limitation to the commercialization of genetic information and innovations (Caulfield, 1999:153). As Callahan (2009) wrote: “United States healthcare system is fragmented, lacks a commitment to universal coverage, and market forces [pharmaceutical companies, medical equipment manufacturers, healthcare providers, medical facilities, group practices, pharmacies, and insurance companies] play a much more prominent role�. A research done by Boston Medical Center and Boston University Schools of Medicine and Public Health reported that five percent of low-income caregivers said they had to make trade-offs to pay for medical care (Kaiser, 2010: http:// www.kaiserhealthnews.org) . This shows that industrial achievements do not automatically translate to welfare. Other countries also choose to develop their biotech business. Over the last several years, the governments of the United Kingdom, China, India, Canada, Singapore and Australia (among others), have been attempting to leverage the process of innovation in stem cell science by implementing a variety of strategies including, but not limited to: dedicated funding programmes, the introduction of specific licensing systems, the implementation of new
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BBS / Spring 2010/ (ID: 4102892) regulations for human cell-based material, emulating US-based venture capital, and encouraging entrepreneurship and spin-off developments. (Harvey, 2010:1) Not just advanced economies such as the countries listed by Callahan, even Thailand “recognized the importance of biotechnology to national prosperity and competitiveness� (Chanvarasuth and Indaraprasirt, 2009). Advances in biotechnology can improve lives. Job creation is a byproduct of biotechnology industry. But the main treatment coming biotechnological advances are too costly to be made freely available for all. Not just cost-related, often state governments prohibit access to certain advances. Turkey for example, outlaws not only domestic but also overseas artificial insemination based on paternity concerns (Head, 2010, http:// news.bbc.co.uk). From this section, we can conclude that currently, access to biotechnological advances rely on a number of criteria: availability of treatment, regulation that allows people to access treatment, ability to afford, individual need, and chances of treatment effectiveness on recipient. So how does governance secure social justice in biotech?
Governance To Secure Global Justice Governance is about the search for how and why collaboration between multiple actors occur: constellation of authoritative rules, institutions and practices (Ruggie, 2005: 307). The issue of governance in biotechnology and social justice is the central theme of this paper because of several reasons (Zacher and Keefe, 2008:18). Firstly, governance influence pattern and constellation of interests and power between actors. Secondly, governance influence evolution and dissemination of knowledge for problem solving. Lastly, governance influence the establishment and development of institutions that facilitate realization of policy preferences. In essence, good governance in human
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BBS / Spring 2010/ (ID: 4102892) biotechnology will be able to protect rights, interests, values, and maintain public confidence and support (Gibbons and Kaye, 2007: 203). There are a variety of factors that shape governance, both at national and international level. Patterns of diseases, existing medical knowledge, development in information technology, interests among actors, and the institutional setting in which all of these factors operate. Therefore the questions that arise in governance of biotechnology are among others: what is shaping relations between politicians, investors, and scientists? might they have common interests in supporting productive investment? What institutions are at work, and how are they shaping biotechnological outcomes? If the state’s role is to fund basic exploration research in bioeconomy (Cooke, 2009:176), where does government revenue come from, and how is that shaping its relations with citizens? Britain is in its effort to revive its manufacturing sector. A report from The House of Commons (2003: 5) stated, “Pharmaceutical biotechnology is the dominant branch of biotech activity in the UK, with a far greater number of companies involved in the sector, agricultural biotechnology is a different industry facing a different set of challenges and so we choose to restrict our focus”. OECD countries have set a policy agenda to build bioeconomy, based on a projection that bioeconomy can contribute to 2.7% of GDP of OECD countries in 2030 (OECD, 2009: 16). In 2002, UK’s biotechnology industry accounted for 42% of the total European biotechnology market capitalization. The output is a massively commercialized treatment, that has potential to favour wealth creation over wealth distribution if not carefully governed. Role of state government in multi-stakeholder partnership
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BBS / Spring 2010/ (ID: 4102892) Governance at national level is catalyzed by policy or user provided drives. Government policies to focus on a particular industry or a particular social development open opportunities for a sector to flourish. Countries with strong scientific base such as the US and UK will inevitably produce scientific knowledge that can be used to advance their economic development through industrialization of scientific knowledge. Balancing wealth creation and wealth distribution is the goal for domestic justice in biotechnology. Revolutionary or not, genetic research rely on the use of databases of human genetic information. Britain for instance, promotes biobanking to advance scientific research in order to find cures for diseases. By the end of April 2010, UK Biobank is reported to have almost close to signing up 500,000 participants to take part in the largest and most detailed research in the relations between genes, lifestyle and health (Doyle, 2010, http:// news.bbc.co.uk). But genetic database raises a number of issues concerning collection, storage, and use. Not only when data comes from within one country, more contentious when data comes from several countries and for non-clinical uses (i.e insurance, employment, forensics). Concerns rise even within the scientific community regarding the database’s legitimacy (i.e. representation of sample population), nature and scope of data (e.g. inclusion of children’s sample). Genetic information has potential commercial value, and this raises more concerns regarding ownership. Through it all, the current governance of biobanks revolve around issues of consent and privacy, involving a range of actors. On consent, whether data can be used for other research related purposes, whether data can be used cross-sector, for example clinical data used for criminal investigation. On privacy, this involves right for information to be concealed and right to know. But who decides and who to hold accountable when things go wrong?
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BBS / Spring 2010/ (ID: 4102892) Here I would like to point out that although partnership and collaboration speeds processes and legitimacy, partnerships hold potential problems as well. Partnerships potentially cloud accountability, reduces focus and influence overall efficiency. The common practice of biotech governance is collaboration between universities, hospitals, venture capitalists, charities, research organizations, pharmaceutical and biotechnology companies, advocacy groups, and so forth. The key is to maintain trust and mutual dependency within and across stakeholders, and the best institution to take up this role is state government through executive and legislative bodies. The state has legitimacy to maintain stability through enforcement of policies, manage different goals with coherent policies and prevent public fear through oversight functions. The governance of database for example. Even when UK Biobank initiative was not based on any specific legislation, it is still subject to other existing legislations such as having to comply with the Data Protection Act on its invitation procedures. On accountability, financially, it is relatively easier to hold actors accountable. Again taking the UK Biobank as an example, it was set up as a charitable company, jointly owned by the Wellcome Trust and the Medical Research Council, even though funding also comes from Department of Health and Scottish Executive (MRC, 2010, hhtp:// www.mrc.ac.uk) . Clearly UK Biobank is a not-for-profit establishment, meanwhile Iceland’s Health Sector Database is a for-profit setup. But accountability for social justice is more difficult to pinpoint as biotechnology is a field that operates on partnerships. Who is accountable for redistribution of advances if the product comes from pharmaceutical company funded research in collaboration with local government and universities? Surely the drive for this partnership is commercial.
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BBS / Spring 2010/ (ID: 4102892) On keeping focus clear, one point to take into consideration is the establishment of regulatory framework and committees in the legislative body that work on protecting social interests from commercialized scientific advancement. It is no doubt that the state act as a catalyst for exploration and financing early research for human biotechnology (Cooke, 2009:164). Commercial drive is based on financial incentive, whereas social drive is based on moral responsibility. The general public operates on moral grounds, but a government albeit democratically represented, has geopolitical agenda that are sometimes in contradiction with moral responsibilities. On maintaining efficiency, a challenge to a good partnership design is distribution of power for decision-making. Partnerships can be unequal as it may be more important for one actor than the other. One actor can coerce the other. Worryingly this is the ultimate weapon of capitalists when dealing with increased regulation: capital flight to another country. For social justice to be secured, the market has to be regulated. “Markets should be the servants, not the masters of public interest� (CSJ, 1994:105). Trials conducted by pharmaceuticals in nations with minimal regulatory framework governing trials is efficient in a way that there is not much restriction to push boundaries, but it comes with concerns that commercial drive trumps over ethical consideration. For science to advance, regulatory framework needs to be in place not to restrict the movement of ideas, but to provide space for innovation. Looking at these challenges, national parliament play a big role in balancing wealth creation and re-distribution of biotechnological advances at national level. The parliament functions include ensuring that there is adequate legislative framework to ensure effective social policies (i.e. make laws, change laws), overseeing that the laws and policies are implemented and that they are effective (i.e. cross sector coherence, targeted at the right
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BBS / Spring 2010/ (ID: 4102892) group by consultations and committees), and represent all groups of societies effectively (industries, citizens, and so on). However, the focus of national governance for social justice is indeed justice within the country’s national boundaries. Another level of governance is required as each nation has self-determination that might not be compatible with other nations’. A global governance mechanism is called for. Biotechnological Global Justice: Governance without Government Governance system of biotechnology at all levels is built on an agreed foundation of ethical principles, a central moral idea that hold individuals as “unites of moral worth and are entitled to equal consideration, regardless of contingencies such as citizenship or nationality” (Tan, 2005:165). The role of governance at international level is to prevent international anarchy and to some degree have the power of intervention when a bloc of actors are causing harm on other blocs. Protection of social justice should also be constructed at international level because: 1) the subject matter of justice in biotechnology are individuals not societies. This means that even though national biotech governance has the ability to secure social justice, the nature of this justice is domestic, not global 2) at international level, anarchy from narrow interests (state and/or industrial) can be managed by an accountability and oversight system that comes from other stakeholders. And 3) National borders have blurred due to globalization and as an effect, collaborations happen with partners from different countries, involving people from different countries as well. This is especially true for collection of genetic sample from various countries. Activities at global level cannot be governed with national mechanisms (e.g. parliamentary legislative power). Human biotechnology is the domain of WHO as the largest international organization and form of governance today. Not only does the WHO look into the use of biotechnology
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BBS / Spring 2010/ (ID: 4102892) in medicine but also health and safety aspects of food produced with biotechnological advances. The WHO serves as a platform for multiple stakeholders to manage product and processes in biotechnology. However, international governance is a more difficult task to perform as countries have sovereignties and the current international governance is not an international government with intervention capacities. In 2005, a convention to ban reproductive cloning was supposed to take place with unanimous support. However, The US and Vatican took another step into banning embryo research, resulting in a weak declaration due to split decisions. In a less controversial issue than cloning is reproductive tourism, which have also become a challenge in global biotech governance and reproductive justice. Reproductive tourism is a profitable venture. While in Czech Republic it costs about $3,000, private treatment in the UK runs roughly US$6,000–$12,000 per IVF cycle (Shanks, 2010, http:www.biopoliticaltimes.org). Although commercially appealing, countries significantly differ in reaction to artificial insemination. Turkey for example, enforces a regulation that imprisons women for up to three years if these women choose to go for artificial reproduction, even surrogacy (Gßrtin-Broadbent, 2010, http://www.bionews.org.uk). Opposing policies such as this make international agreement more difficult to achieve. There is much to be done to develop biotech governance at international level. One of the most important is an international enforcement and oversight structure that represents state governments, industries, scientific community, advocacy groups and general public. International governance plays a role of not only to police transnational behaviour, but also to build collaborative frameworks. This leads to the question: legal force or social accountability in international governance? Given that WHO failed to negotiate a binding international convention on cloning, it is clear that international legislation is not the only way to govern biotech. However, there is
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BBS / Spring 2010/ (ID: 4102892) another route that governing as governance can take place, and that is by linking social accountability to trade. This is also not without challenges. The current Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) heavily limits access to developing countries and becomes a barrier to genetic research due to genetic patenting. WHO as a world organization is on the right track for engaging the global community in the process of crafting effective legal framework. But it is not yet effective as there is still a struggle for freedom from regulation in the scientific community (i.e. via the establishment of bioethics, which is to some degree ‘flexible’ at national level). There is no doubt that some form of regulatory framework is needed, but the next challenge is also in the lack of definition in biotechnology, making it more difficult to build a sound legal framework. The words “therapy” and “enhancement” for example, are used interchangeably depending on which one steers away from regulations farther, and the fact that techniques between the two overlap also does not help with clarification. What is most needed at global level, be it governance or regulation is incentive to be involved in the first place, followed by consensus on what biotechnology needs to balance scientific advancement, commercial value and social justice.
Conclusion This essay began with an exploration of the linkages between justice, health and biotechnology. Biotechnology holding the capacity to modify a person’s genetic make up has potential to create dual-inequalities, that one can be a ‘better’ human, and that these treatments are only available to those who can afford, but not via universal provision. The government steps into the equation by pursuing social justice in various ways. Wealth creation as a path is followed by industrious states following the premise that industrial advancement will generate more opportunities for people to be able to access
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BBS / Spring 2010/ (ID: 4102892) biotechnological advances. Biotechnology is a vibrant industry and believed (albeit mythical) to be able to solve biological problems. The immediate challenge when pursuing justice through means of commodification is that there are partnerships to govern. State government has to be the controlling actor as it is the only institution that has the capacity to enforce and oversee that partnerships work for all groups of societies within its national boundaries. The state government has binding arbitrary power on its people and businesses, and with a good national governance, countries can pursue their national interests. Even though a lot of weight is put upon the state government’s role in securing justice, they are in fact jeopardizing social justice by fostering industrial development and commercialization of biotechnology as wealth creation. For social justice in biotechnology to happen, governance at international level has better capacity to manage narrow national interests against a backdrop of other countries’ interests. With each country having their own self determination, an international level of governance is required as countries don’t always have compatible interests. Not only managing interests, international governance is also required to stabilize practices that involves people in different countries such as in the collection, storage and use of genetic information. The challenge of international governance is that currently, no international basic structure have been established. The WHO acts as an engagement platform, but not as an enforcement agent. For governance at international level to be effective in securing social justice, incentive must be made available for all stakeholders to be willing to be involved. Consensus is also needed for a number of items, especially when it comes to crafting binding international regulations. In denouement, to answer the question how can effective social justice be secured through national and international governance of human biotechnology, the answer lies in
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BBS / Spring 2010/ (ID: 4102892) the creation of a sound collaborative framework at both levels. National governments must take the leading role at national level, and a stronger international institution must take place at international level, making sure that even if the world operates on a market-based system, social accountability of all actors is the balancing mechanism.
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References Biotechnology Industry Organisation/BIO (2009) “State Legislative Best Practices in Support of Bioscience Industry Development”. Washington: BIO Callahan, Daniel (2009) “Medicine and The Market” in Arnold, Denis G (ed) Ethics and The Business of Biomedicine, Cambridge: Cambridge University Press pp. 20-34 Caulfield, Timothy (1999) “Regulating the Commercialization of Human Genetics: Can We Address the Big Concerns?” In Ruth F. Thompson and Alison K. Chadwick (eds) Genetic Information. New York: Kluwer Academic/Plenum Publishing. pp. 149–61 Chanvarasuth, Nataporn and Ramjitti Indaraprasirt (2009) “Thailand Biotech Business:Product of The National Policy” in Journal of Commercial Biotechnology Vol 15, pp 66 – 72. Corrigan, Oonagh and Richard Tutton (2009) “Biobanks and challenges of governance, legitimacy and benefit” in Atkinson P, Glasner P and Lock M (eds.) Handbook of Genomics and Society: Mapping The New Genomics Era. Abingdon: Routledge pp. 302-318 Cooke, Philip (2009) “State, Markets and Networks in bioeconomy Knowledge Value Chains” in Atkinson P, Glasner P, and Lock M (eds.) Handbook of Genomics and Society: Mapping The New Genomics Era. Abingdon: Routledge pp 163-180 Commission on Social Justice/CSJ (1994) “Social Justice Strategies for National Renewal: The Report of The Commission on Social Justice”, London: Vintage Daniels, Norman (2008). “Just Health: Meeting Health Needs Fairly”, Cambridge: Cambridge University Press Daniels, Norman, Bruce Kennedy, Ichiro Kawachi (2000). “Justice is good for our health”. Boston Review Vol 25 p.1 Gibbons, Susan MC and Jane Kaye (2007) “Governing Genetic Databases: Collection, Storage and Use”, in Kings Law Journal 18 (201-208) Hale, Benjamin and Lauren Hale (2009). “Is Justice Good for Your Sleep? And Therefore Good For Your Health?”. Social Theory and Health Vol. 7 No. 4, pp. 354-370
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BBS / Spring 2010/ (ID: 4102892) Harvey, Olivia (2010) “Innovation and commercialisation in the stem cell industries in Australia: State strategies and other opportunities to build a competitive position in the global stem cell economy” in Journal of Commercial Biotechnology Vol 16, pp 72 – 83. House of Commons, Trade and Industry Committee (2003) “UK Biotechnology Industry: Twelfth Report of Session 2002-2003”, London: The Stationery Office Limited Kerr, A (2004) Genetics and Society: A Sociology of Disease. London: Routledge Ch 4 pp 64-83 OECD (2009) The Bioeconomy to 2030: Designing a Policy Agenda. Ruggie, John G (2005) “American Exceptionalism, Exemptionalism and Global Governance” in American Exceptionalism and Human Rights, ed. Michael Ignatieff. Princeton: Princeton University Press pp. 307 Tan, Kok Chor (2005) “Cosmopolitan Impartiality and Patriotic Partiality” in Weinstock Daniel (ed) Global Justice, Global Institutions, Alberta: University of Calgary Press Wright, Susan (1994) “The Social Transformation of Recombinant DNA Technology, 1972-1982” in Wright, Susan, 1994, Molecular Politics: Developing American and British Regulatory Policy for Genetic Engineering. Chicago: University of Chicago pp 65-109 Zacher, Mark W and Tania J Keefe (2008) The Politics of Global Health Governance: United By Contagion. Hampshire: Palgrave Macmillan
Internet Resources Doyle, Keith, “UK Biobank 'close to signing up 500,000 participants' (24/04/2010)”, http:// news.bbc.co.uk/1/hi/health/8640933.stm date accessed 27/04/2010 Gürtin-Broadbent, Zeynep, “Problems with legislating against reproductive tourism (22/03/2010)” http://www.bionews.org.uk/page_56954.asp?iruid=2268 date accessed 03/05/2010 Head, Jonathan, “Turkey bans trips abroad for artificial insemination (15/03/2010)”, http:// news.bbc.co.uk/1/hi/world/europe/8568733.stm date accessed 27/04/2010
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BBS / Spring 2010/ (ID: 4102892) Kaiser Health News, “Kids' Health Can Suffer When Parents Must Choose Between Health Care And Basic Necessities (03/05/2010)”, http://www.kaiserhealthnews.org/DailyReports/2010/May/03/Health-Care-Choices.aspx date accessed 03/05/2010 Medical Research Council/MRC (2010) “Our Research: UK Biobank” http://www.mrc.ac.uk/ Ourresearch/Ethicsresearchguidance/Biobank/index.htm date accessed 03/05/2010 Shanks, Peter, “Struggling to Control Fertility Tourism (17/04/2010)” http:// www.biopoliticaltimes.org/article.php?id=5156 date accessed 03/05/2010 Robin McKie, “Why genius isn't in the genes (02/05/2010)”, http://www.guardian.co.uk/ theobserver/2010/may/02/david-shenk-genius-genetics date accessed 03/05/10
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