Pharmacogenetics in the clinic

The past two chapters have shown how Roche mobilised support behind Herceptin and moved it into clinical practice in the UK. This chapter is about what happened when it got there. Thus we have moved from broad issues about how you get a pharmacogenetic drug into clinical practice, to the small-scale, ‘micropolitics’ of the clinical encounter (Waitzkin 1991). Within this context the ‘shape’ the technology takes is influenced by the institutional and cultural setting within which it comes to be used. We have seen how Herceptin is seen by many in the media and outside oncology as a clear example of pharmacogenetics, the first drug of its kind to make it into clinical practice, and how Roche managed to get Herceptin into the clinic by enrolling a variety of actors in a network of support behind the new drug. This chapter starts by looking at how clinicians see Herceptin in terms of its value as a treatment. It then moves on to discuss the way in which HER2 testing and Herceptin are presented to patients: what women are told about HER2 testing and their eligibility for Herceptin.