Personalised medicine: From promissory science to infrastructural ethics

Arribas-Ayllon, Michael ORCID: https://orcid.org/0000-0003-2669-2781 and Papillon, Daniel 2026. Personalised medicine: From promissory science to infrastructural ethics. Encyclopedia of Applied Ethics [3rd edition], Reference Module in Social Sciences, Elsevier, (10.1016/B978-0-443-15715-8.00049-2)

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Abstract

Personalised medicine has been widely framed as a genomic revolution, promising predictive prevention, targeted therapies and empowered health citizenship. This article argues that these futures have been realised less as clinical transformations than as institutional accomplishments, sustained through an economy of expectations. It develops an expectation audit that tracks how promises, proof conditions, frictions and redistributions co-evolve across three regimes: polygenic risk scores, precision oncology, and consumer genomics. Across these domains, promissory claims continue to mobilise investment and coordination even when clinical benefits remain modest or uneven. Polygenic prediction advances in algorithmic performance but struggles to yield actionable value at the bedside, while raising portability and equity concerns. Precision oncology has built powerful sequencing and trial infrastructures, yet therapeutic gains are frequently partial and access stratified. Consumer genomics expands participation and data extraction through empowerment narratives, despite limited behavioural impact and contested data politics. The audit shows how “in-between” states of partial realisation become durable, how frictions are repurposed as further work and how authority shifts from clinical encounters to platform infrastructures. The article concludes that an ethics adequate to anticipatory governance must evaluate not only outcomes but the infrastructures and narratives that decide which futures become actionable, and for whom.

Item Type:	Book Section
Date Type:	Published Online
Status:	In Press
Schools:	Schools > Social Sciences (Includes Criminology and Education)
Publisher:	Elsevier
ISBN:	9780443157851
Last Modified:	04 Aug 2026 22:16
URI:	https://orca.cardiff.ac.uk/id/eprint/186721

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