How sanitary pads came to save the world: Knowing inclusive innovation through science and the marketplace.

International development institutions, governments, and social entrepreneurs have become increasingly enthusiastic about 'inclusive innovation' which, to solve problems in low- and middle-income countries, focuses on the development of technologies for and by the poor. Inclusive innovation differs from previous development efforts by focusing on devices instead of infrastructure, claiming to be based on scientific evidence, and relying on market logics to achieve humanitarian ends. Proponents argue that, informed by grassroots efforts, these interventions have enormous potential to catalyze economic, social, and political change. How are the market and technological imperatives of inclusive innovation shaping the international development agenda? What do inclusion and innovation mean in this context? What can inclusive innovation tell us about the proliferation of initiatives that promote technology for public good, from responsible innovation to public interest technology? This article examines these questions through a case study of menstrual hygiene management (MHM) innovation in India. Rather than providing solutions to self-evident development problems, inclusive innovation shapes both development problems and solutions simultaneously, in areas where scientific and market ways of knowing converge. These ways of knowing claim to be legitimate because they are rooted in local knowledge and expertise. MHM in India became a problem, and low-cost disposable sanitary pads an inclusive innovative solution, because of the involvement of Indian researchers and innovators, and Indian girls and women as consumers and producers. However, in the process they reinforced narrow understandings of both inclusion and innovation in international development. Inclusion efforts may be wrapped up in political economies that shape and limit their transformational power by prioritizing scientific, technical, and market expertise.

Assessing the social impact of direct-to-consumer genetic testing: understanding sociotechnical architectures.

To properly understand the social impact of direct-to-consumer genetic testing, we must consider the "sociotechnical architectures" of these technologies--how developers design and assemble the human and technical components of individual testing systems to perform specific functions. In particular, the way testing systems perform their main functions--providing access to testing, analyzing genetic material, and conveying test results--influence the technology's utility and the distribution of expertise in the medical system. I illustrate this concept by comparing two systems that offer single-nucleotide polymorphism analysis, a relatively new type of genetic testing. I conclude by exploring how policy officials and other decision makers might intervene in the development of sociotechnical architectures to maximize the benefits of genomic technologies.

The patent is political: the consequences of patenting the BRCA genes in Britain.

OBJECTIVES: The paper explores the attempt by an American biotechnology company, Myriad Genetics, to use its patent rights over the BRCA genes to transfer its technology of genetic testing for breast and ovarian cancer to Britain. It also investigates the responses of British scientists, health care professionals and patient advocates to this attempted technology transfer. METHODS: This paper is based on approximately 100 in-depth interviews, document analysis and ethnographic observation conducted in the United States and Britain from 1998 to 2001. RESULTS: The BRCA gene patents inspired political resistance and mobilized opposition to the patenting of genes in general. They also provided an opportunity for the British to assert their national identity as they argued that a British BRCA testing service needed to be available within the context of the National Health Service to all citizens equally. CONCLUSIONS: Patents are not only legal documents and technical descriptions, but political tools as well. As they are increasingly deemed vital to economic globalization, patents have become mobilizing tools for anti-globalization activists and non-governmental organizations from less developed countries, and for asserting local and national identities.

Architectures of genetic medicine: comparing genetic testing for breast cancer in the USA and the UK.

This paper compares the development of genetic testing for breast cancer (BRCA testing) in the USA and the UK. It argues that national political cultures played an important role in how these genetic testing technologies were shaped, and that the shapes of these technologies had important implications for the users of these systems. In order to demonstrate the roles of national social and political elements in the development of new genetic testing technologies, I introduce the concept of a technology's architecture, which is made up of components and the specific ways in which these components are assembled to fulfill particular functions. In the USA, four very different BRCA testing systems initially emerged. However, one biotechnology company, Myriad Genetics, eventually used its legal and economic position to become the sole provider of testing. It offered BRCA testing the way many other laboratory tests were provided in the USA, available to anyone through any physician. The shape of this testing service had important implications for its participants, defining the client as a consumer who could demand access to any of Myriad's laboratory services, but could not choose among testing systems. In the UK, the government-run National Health Service provided testing through regional genetics clinics, using family history information to assess risk and triage care. Clients in the UK were defined as citizens and patients, who had the right to equal access to the testing system but could not demand any specific services.