A technology's architecture: who win and who loose

Parthasarathy (2005) introduces a technology’s of architecture (TA) which is “made up of components (for example, steel beams and concrete) and specific ways in which these components are fitted together to fulfill specific functions” (Parthasarathy 2005, 7). He describes a conceptual framework of TA in order to analyze the testing system which discovers genes linked to inherited susceptibility for breast and ovarian cancer (BRCA genes). The testing system must, he claims, have “(1) direct individuals to testing, (2) assess their eligibility, (3) inform them about potential risks, (4) benefits, (5) implications of the test, (6) extract material or information for testing by a technical apparatus, and (7) report the results (Parthasarathy 2005, 7).”

Let me begin with the first component, “direct individuals to testing”. Depending on culture and specific kind of test, directing method may be different, he argues. In my view, the actual directing individuals, in testing system of BRCA, is done by neither newspaper advertisement nor an advice of physician. Directing, in my opinion, is done by (1) having insurance and (2) coverage of the insurance especially in US. If a citizen has a health insurance policy, it is likely that she will see her provider who is likely to suggest the test. If a citizen does not have health insurance, it is likely that she will see her provider and there is no possibility of assessing her risks.

Second, who access the users’ eligibility? Providers may suggest the test. However, the suggestion does not matter if the patient does not have health insurance. The eligibility to access the test is finally determined by the insurance company of the patient. There are many loopholes in implementation and executing health insurance policy. Insurance companies have sole authority to deny a claim for many reasons. For example, if an insured person did not disclose pre-existing conditions, he or she can be denied for coverage. For those who do not have health insurance, either being poor or having some other reasons, they have no rights to access the test. You may argue that those who do not have health insurance are finally ended up at emergency rooms and they could still get care and treatment. However, I would say, emergency rooms do not provide the BRCA test, in most cases because it is not emergency nature.

Since the first two components that are influenced by external factors (health insurance policy, and authority rested at the hands of those insurance companies), all the components in the system does not fit and work properly together. In fact, the technology was innovated for the entire sake of patients, end users. However, their luck for having access to the technology or test depends too much on the external factors. No matter what factors influence the eligibility of a patient, the company which invested in the technology has reaped the profits. The insurance companies get huge profits from denying care for patients. Parthasarathy’s (2005) view does not include (1) equal distribution of wealth, (2) affordability and (3) accessibility to the healthcare in a bigger picture. His exclusion of the factors may be justified in a country where universal health care system is in practice, such as Canada or UK.

References

Parthasarathy, S. 2005. Architectures of genetic medicine: Comparing genetic testing for breast cancer in the USA and the UK. Social Studies of Science 35(1):5-40.