Practice and public policy in the era of gene-environment interactions.

This chapter argues that implications of the gene-environment interaction revolution for public policy and practice are contingent on how the findings get framed in public discourse. Frame analysis is used to identify the implications of the ways in which findings are cast. The frame of 'defective group' perpetuates racial and class stereotypes and limits policy efforts to redress health disparities. Furthermore, empirical evidence finds it inaccurate. The frame of'defective gene' precludes the adaptive genetic significance of genes. The frame of 'individual genetic profile' offers individualized health care but risks misapplication in policies that place responsibility for disease prevention on the individual to the policy relief of industry and toxic environments. Framing the interaction in terms of 'defective environments' promotes the identification of harmful environments that can be regulated through policy. The 'therapeutic environment' frame offers hope of discovering interventions that have greater precision and effectiveness but risks dis-incentivizing the pharmaceutical industry from discovering drug treatments for 'obscure' gene-environment match groups. Can a more accurate and helpful framing of the gene-environment interaction be identified? Findings that genes shape environments and that environments alter the gene pool suggest a more textured and symbiotic relationship that is still in search of an apt public framing.

Duke Scholars

Author Kenneth A. Dodge Sanford School of Public Policy