The interplay of the Sociotechnical imaginaries and policies of personalized healthcare in the Netherlands

Abstract

Personalized medicine is a new and fast-rising scientific field in the Netherlands. It is well-established that personalized treatments and drugs are more effective than conventional medicinal practice. This study aims to determine the following: The current collective expectation of personalized medicine, its evolution over time, and the interplay between policy practices and other competing expectations. This is done by the analysis of the Sociotechnical Imaginaries of personalized medicine. This study is carried out to advance theoretical knowledge of Sociotechnical Imaginaries and to help improve policy implementation in the field of personalized medicine. In this context, collective expectations of CAR-T cell therapy, a personalized cancer treatment, are used to represent the concept of personalized medicine in the Netherlands. The theory of sociotechnical imaginaries is about the collective expectations of desirable visions of technology in society and their influence on the advances in technology and science. The dimensions of the national sociotechnical imaginaries used in this research are: national needs, solidarity, temporality, competitiveness, risks & benefits. To analyze the collective expectations of CAR-T over time and the interplay between policy and competing expectations, interviews with key actors in the CAR-T field have been interviewed about their expectations. In addition, a media framing analysis over the period 2012-2021 of CAR-T cell therapy was performed. The results show two dominant competing sociotechnical imaginaries in the field of personalized medicine in the Netherlands. These sociotechnical imaginaries are ‘Pharmaceutical Inclusion’ and ‘Academic-driven pharma’. ‘Pharmaceutical Inclusion’ imagines a future with more inclusion, cooperation, and influence of pharmaceutical companies within healthcare and governmental institutions. The ‘Academic-driven pharma’ envisioned a future with academic CAR-T development and production with less pharmaceutical influence in healthcare. An analysis of the results shows the impact the two competing sociotechnical imaginaries have on each other. They frame the competing STI by emphasizing the risks and ignoring its possible benefits. The analysis also shows that the evolution of the STIs is influenced and enabled by policies, just as the policies themselves are influenced by the STIs. On this basis, knowledge of the competing STIs should be considered when designing policies or for substantial discussions on possible technological trajectories.