Book Review

French DNA: Trouble in purgatory

N Engl J Med 2000; 342:982-983March 30, 2000

Article

French DNA: Trouble in purgatory
By Paul Rabinow. 201 pp. Chicago, University of Chicago Press, 1999. $25. ISBN: 0-226-70150-6

In French DNA, anthropologist Paul Rabinow makes the case that the “basic understanding and practices of `bare life' have been altered” by the revolution in genetics. Seen as essential, irreducible, and fundamental, DNA can stand in for the whole person (or even culture) and is subject to various kinds of “spiritual identification.” Is there, for instance, such a thing as French DNA? The question, he asserts, is still open, and it defies existing systems of understanding. The resulting “purgatorial space,” as Rabinow puts it, remains to be filled. He points to the program of a French research institute, the Center for the Study of Human Polymorphism (CEPH), as one model of how that might happen.

Calling CEPH courageous and visionary for its innovative mix of genomics, public health, and finance, Rabinow eagerly accepts its director's invitation to act as a “philosophic observer” for six months. Once he gets to CEPH, Rabinow discovers the story he wants to tell. He hovers at the center of this story, and his report frequently takes the form of first-hand journal entries recounting the maneuverings of CEPH's director and staff members. Not until the epilogue does he offer justification for his unusual place in the story. For Rabinow, it appears, the institutional boldness required to make sense of the new genetics (as embodied in research by CEPH) can be matched only by conceptual boldness on his part. Claiming an “ethic of experimentation,” Rabinow justifies his “insiderness” at the same time that he distinguishes its effect from that of a host of anthropologic, sociological, and historical methods. (And here he does, indeed, make bold claims.) Categories such as culture and society, he asserts, “are in conceptual ruins.” And to move beyond these ruins, he continues, anthropologists' “concepts and our modes of work must themselves be capable of making something new happen in a field of knowledge.” In French DNA, Rabinow is an activist, both in his anthropologic stance and in his optimism about the outcomes genetic interventions might make possible. “A humanism that is highly suspicious of human intervention,” Rabinow writes, “is a humanism that has lost its nerve.”

Since I am neither an anthropologist nor a philosopher, but rather a documentary filmmaker working in the area of science and society, I must leave the assessment of Rabinow's philosophical claims to his academic peers. What is clear, however, is that Rabinow's method depends on his success in capturing the event (or, for the purposes of book reviewing, the story) at the heart of his analysis. And despite a number of fascinating chapters, some elegant writing, and a provocative and thoughtful effort, the drama at the heart of French DNA fails to live up to its billing.

The book's story line is a very particular one: it follows the main characters and events surrounding an ultimately unsuccessful business deal between CEPH and an American biotechnology company (Millennium Pharmaceuticals). Characterized by Rabinow as a “singular instance of a multidimensional crisis,” the goal of the collaboration between CEPH and Millennium was to discover the genetic basis for certain common forms of diabetes. As Rabinow recognizes, the public health implications of such discoveries are substantial, and the potential market, he suggests, “is extravagant.”

The deal appealed to the director of CEPH because Millennium was developing potentially rapid and powerful new forms of technology for gene discovery and because, unlike potential French sources of funding, it was well financed. In return, CEPH offered access to its collection of familial genetic material, a critical component in the search for genes. With often fascinating detours through the controversy about the contamination of the French blood supply by the human immunodeficiency virus (HIV), the relative merits of French and American views of bioethics, and the idiosyncrasies of French research and business models, Rabinow chronicles the deal as it falls through. In the first few pages of the book he describes a French government official's argument for blocking the collaboration: “CEPH was on the verge of giving away to the Americans that most precious of things — something never before named in such a manner — French DNA.” For the next 180 pages, Rabinow explores this possibility.

Although it is easy to see that the collapse of the CEPH–Millennium deal (and, in effect, the CEPH “vision”) probably constituted high drama to those involved and could even crystallize important larger issues about the intersection of science, business, and ethics, Rabinow fails to make, as he claims “something new happen.” Instead, French DNA seems disjointed: it is uneven in its emphasis, inconsistent in its style, and, at times, random in its descriptive detail. The prominence given to the CEPH–Millennium narrative more often distracts than illuminates.

Rabinow tries to capture the urgency and drama of events with (sometimes breathless) present-tense reporting and personality profiles, but his preoccupation with things like dress (“open white shirt, mustard-colored jacket, charcoal linen pants”), background (“herself of Tunisian Jewish origin”), and more problematically, what individual persons report about themselves, is unexamined and often annoying. The gossip at Parisian dinner parties does little to further his analysis or even thicken his story. Had the CEPH–Millennium deal taken up a chapter or two — even a central chapter — the story would probably have been much more effective. As the storyteller (whatever his philosophical claims), Rabinow does not exercise adequate discipline over his narrative voice or maintain sufficient critical distance from his subject.

The book is most successful when Rabinow steps back from the present-tense narration to analyze the constellation of forces and values that play into the larger questions raised by emerging forms of genome technology. How do knowledge, ethics, and business intersect? What role do nationalist legacies play in defining life? What social conditions allow for meaningful interventions and still safeguard against abuse?

In chapter 4, for instance, Rabinow explores how French ideals of collective social values, scientific advancement, and the universal dignity of the human body contributed to the reluctance of officials to screen donated blood for the presence of HIV, a delay that seriously compromised the French blood supply in the 1980s. In the same chapter, Rabinow compares French and American bioethical traditions, their respective adherence to collective and individual rights, and their relative connection to the state. In France, Rabinow writes, “The body does not belong to the person but to French society.” Citizens are expected to donate their organs, and the body “cannot circulate in commerce.”

Equally interesting comparisons are made in chapter 6, where Rabinow describes French business models and their effect on technological innovation. Until recently, for instance, French companies were not allowed to be listed on the stock exchange until they turned a profit, an obvious hindrance to entrepreneurial efforts such as those at CEPH or in the American market.

Overly seduced by the CEPH–Millennium drama (and perhaps his own place in it), Rabinow still manages to raise deep and deeply interesting questions about the meaning of DNA. His sustained interest in the meaning of the human body in culture, how it is recognized and regulated, and what effect genetics will have on it makes French DNA worth reading. Recent events, such as the decision of Iceland's legislature to “lease” the DNA of the country's citizens to a pharmaceutical company, make it highly relevant.

Noel Schwerin
Backbone Media, San Francisco, CA 94131