24 November 2020

BioValue and DTC Genomics Marketing

'A tidal wave of inevitable data? Assetization in the consumer genomics testing industry' by Susi Geiger and Nicole Gross in (2021) Business & Society comments 

We bring together recent discussions on data capitalism and bio-capitalization by studying value flows in consumer genomics firms – an industry at the intersection between healthcare and technology realms. Consumer genomics companies market genomic testing services to consumers as a source of fun, altruism, belonging and knowledge. But by maintaining a multisided or platform business model, these firms also engage in digital capitalism, creating financial profit from data brokerage. This is a precarious balance to strike: If these companies’ business models consist of assetizing the pool of genomic data that they assemble, then part of their work has to revolve around obscuring to consumers any uncertainties that would potentially impinge on these processes of assembly. We reflect on the nature of these practices and the market relationships that enable them, and we relate this reflection to debates around alternative market arrangements that would potentially mitigate the extractive tendencies of these and other digital health firms.

The authors argue 

In July 2018, a number of consumer genomics companies - including the industry’s leaders Ancestry.com and 23andMe –signed up to a new data privacy protocol, which had been developed in conjunction with the data activist organization Future of Privacy Forum (FPF) (Romm & Hartwell, 2018). These best practices include provisions for express and fully consented sharing of genomic data with third party organizations (Future of Privacy Forum, 2018). While focusing attention on the firms’ privacy practices, the guidelines remain surprisingly silent of the fact that the commercial “sharing” or sale of genomic data is an intrinsic part of these firms’ business models. Questions of data privacy in consumer genomics are inseparable from questions of data ownership and the profits arising thereof; yet the former has received vastly more research and public attention than the latter. 

In this article, we broaden recent discussions on data or platform capitalism as practiced by data-driven technology firms such as Google or Facebook (Langley & Leyshon, 2017; West, 2017) by considering healthcare as a realm that is becoming increasingly entangled with data capitalist business models. As Atkinson, Glasner and Lock (2009, p. 5) point out, the bio- economy “generates a different form of value to that found in the wider economy”, namely value that always entangles economic with social and public concerns. But where and to whom does this economic value accumulate if it goes digital? What are the market arrangements and business models that enable economic value to flow in these so-called digital health industries, and are there any alternatives to the current models? 

By locating our inquiry in the consumer genomics industry, we study an industry that has been embroiled in controversies from its earliest days – in Cole and Banerjee’s (2013, p. 555) words, it is “morally contentious”. Social science commentators have raised questions around the mantle of democratization of health insights and clinical research that the consumer genomics industry likes to cover itself with (Prainsack, 2014; Regalado, 2017; Tutton & Prainsack, 2011). The industry has also encountered enduring skepticism from clinicians around the provision of worrying and even misleading information to consumers without the benefit of professional medical support (Rockwell, 2017). Despite these criticisms, judging by the industry’s growth rates (Deloitte 2015), consumer genomics companies seem to have been successful at portraying genomic information as a font of empowerment, belonging and knowledge to consumers (Turrini & Prainsack, 2016). 

While alert to these ethical debates, in this article we focus on the processes through which consumer genomic information is turned into assets, which allows these firms to operate on several markets at the same time – consumer, data licensing, venture capital and intellectual property markets. Following Birch (2017, p. 463), we define assets as “resources that generate recurring earnings”. We contend that for consumer genomics firms’ business models to work, there is a precarious balance to strike: If these companies aim to assetize the pool of genomic information that they assemble, then part of their work has to revolve around assuring an uninterrupted flow of data that can be turned into assets. We claim that this is done through three interlinked processes: of first accumulating consumer data; secondly, maintaining and augmenting it; and thirdly obscuring to consumers any uncertainties that would potentially impinge on first two processes. In tracing the value flows in this industry, we thus examine the practices that these companies engage in with regard to assetizing genomic information. More broadly, we argue that the move to assetization presents a major conceptual shift for firms that operate broadly in the healthcare realm. Conceptually, we combine theories of biocapital and data capitalism to analytically grasp and critique these processes of assetization. 

While our argument is conceptually driven, we draw on several empirical sources to inform our analysis: We examine genomic firms’ business models and market relationships through an analysis of their marketing collateral and websites, and we support this analysis through documents published either by the firms themselves or by technology journalists and analysts. We complement these documentary sources through eight interviews with industry insiders. Our investigation remains on the producer side – we study how consumer genomics firms “act in markets to affect what is valued and how it is valued” (Aspers & Beckert, 2011, p. 23), not how this value is perceived and realized by the consumer. Though we focus predominantly on economic value flows, we fully acknowledge that there are various values at play – ethical, social, and individual. Yet, as Rose and Novas (2005) point out, in markets these are often conflated with or even turned into “marketable assets” themselves. Comparing our findings with extant research, we discuss the “inevitability” of the private accumulation of economic value from consumer genomic data, to which our title refers,1 and we point to debates around alternative market arrangements in consumer genomics and the broader bio-economy. With this reflection we contribute to discussions on valuation and assetization practices at the intersection of individual, healthcare and commercial realms (Dussauge et al., 2015; Poitras & Meredith, 2009). We also add to an emerging literature scrutinizing the intersection of digital technology and healthcare practices in so-called digital health industries (Geiger & Gross, 2017; Fiore-Gartland & Neff, 2016; Saukko, 2018). Most fundamentally, our argument speaks to Birch’s (2017) question of what gets valued and how this is done in the bio-economy. 

Our article proceeds as follows. The next section introduces three strands of literature around “capitalisms” - bio-, data- and platform - bringing insights from the practices researchers have identified in data and platform capitalist firms into debates around biocapitalization. After briefly presenting our analytical approach, we use these conceptual foundations to first analyze the four value flows we have identified as constituent parts of a typical consumer genomic business model. We then explore 15 direct-to-consumer genomic testing firms’ marketing strategies to establish how these firms endeavor to create and maintain the “tidal flow” of data that underlies these value flows. Our Discussion summarizes our analysis before moving to build a research agenda for future research, centering on debates around conceiving alternative market mechanisms in the consumer genomics and related digital health industries.