The awards committee, composed of current and past directors of the Society and previous award winners, has announced that the 2008 Accomplishment by a Senior Scientist Award will be given to David Haussler of the University of California Santa Cruz, Santa Cruz, California, United States, and the 2008 Overton Prize for outstanding achievement in early to midde career will be awarded to Aviv Regev of MIT and the Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States. Both award winners are Associate Editors for PLoS Computational Biology, an official journal of ISCB.Each year, the International Society for Computational Biology  2008, where the winners will give Bioinformaticians worldwide owe a debt to David Haussler see  for his PLoS Computational Biology, has made significant contributions to the study of DNA–protein interactions and the prediction of nucleic acid structure and function; Myers was one of the inventors of the BLAST program, a key innovator in shotgun sequencing, and a principal architect of Celera's draft sequence of the human genome.Haussler originally trained as a mathematician, graduating magna cum laude from Connecticut College and obtaining prizes for mathematics at both Bachelor's and Master's levels. His first encounter with computational biology came in graduate school, at the University of Boulder in Colorado, where he had the good fortune to study for his Ph.D. under Andrzej Ehrenfeucht. “Andrzej is an extraordinary man,” says Haussler. “In our weekly research seminars, we would discuss topics ranging from dinosaur flight to abstract graph theory. He taught me that I should never be constrained by disciplinary boundaries, and never be frightened to tackle big problems. The word “bioinformatics” didn't exist when I was a graduate student, but we were doing it.” Two of his fellow students, Gary Stormo and Gene Myers, have also gone on to have distinguished careers in the field. Stormo, now professor of genetics at the University of Washington in St. Louis, and Deputy Editor-in-Chief of Biological Sequence Analysis: Probabilistic Models of Proteins and Nucleic Acids. Other members of Haussler's group applied machine learning techniques to the classification of microarray data, including the development of one of the first expression-based methods for distinguishing tumor from normal cells.Haussler's first years as an independent investigator were devoted to rather abstruse studies in pattern recognition and machine learning, focusing on modelling the way the brain learns. He only shifted from computational neuroscience back to bioinformatics when Anders Krogh joined him at Santa Cruz as a post-doc. Characteristically, Haussler underestimates his own role in their joint achievements. “Anders was an exceptional post-doc, who has gone on to have an exceptional career as an independent scientist. He came to my lab to work on machine learning, but soon discovered that these methods could be applied to biological sequence analysis, to classifying proteins into families and recognising genes in fragments of DNA.” Krogh is co-author of acclaimed and popular textbook Late in 1999, a phone call changed the direction of Haussler's research. “I was called by Eric Lander, one of the leaders of the public human genome sequencing project, and asked to apply my HMM methodology to identifying the genes in the then newly sequenced human DNA,” he explains. At that time, the public project was in a “full-on race” with Celera to publish an initial working draft of the sequence. Haussler joined the international public effort, rapidly recruiting a team of talented young bioinformaticians that included Jim Kent, winner of ISCB's 2003 Overton Prize.Barely six months after Haussler joined the project, both teams—the publicly funded one and Celera's—were ready to release their first genome drafts into the public domain. Haussler well recalls July 7, 2000, when the complete draft genome sequence was posted on the University of Santa Cruz' Web server. “Seeing the waterfall of As, Gs, Cs, and Ts pouring off our server was an emotional moment,” he says. “We were witnessing the product of more than three billion years of evolution, sequences passed down from the beginning of life to present-day humans.” This excitement was shared by the worldwide scientific community; Internet traffic on the Santa Cruz server reached 0.5 terabytes per day then: a record that still stands.Raw DNA sequence, however, is not much use on its own, and Haussler has dedicated the first years of the new millennium to mapping and analysing that sequence. The first release of Santa Cruz' genome browser went online shortly after the human sequence was released, and it now includes twenty complete vertebrate genome sequences, plus those of a few representative invertebrates. “The publication of the second vertebrate genome—that of the mouse—gave us the first real sequence-based insights into the mechanisms of vertebrate evolution,” he says. “And we could also use evolutionary theory and sequence analysis to answer a central question: how much of the mammalian genome is ‘junk’?” Assuming that fewer inter-species substitutions are found in functional DNA than in non-functional DNA, Haussler's team in the mouse genomics consortium were able to estimate that at least 5% of a mammalian genome is functionally important. This value has been confirmed as more complete sequences have emerged. “We may think that 5% is a small value, but it is particularly interesting in that less than 1.5% of the genome codes for proteins. There is still a question over the function of much of the 3.5% that is conserved but does not form protein-coding genes.” Other questions that have attracted Haussler's attention include the analysis of hyper-conserved DNA sequences that remain virtually unchanged in divergent species, and the genetic changes that distinguish humans from apes. While most researchers in this field have concentrated on gene gain during evolution, Haussler and his team recently identified twenty-six genes that are well-established in the vertebrate lineage but that were lost in the latter stages of human evolution.Brunak describes the 2008 Overton Prize winner Aviv Regev see  as “a roThe idea that led directly to her graduate studies, however, came from a branch of computational science that at first glance has little, if any, connection with biology: pi calculus, typically applied to problems in electronic engineering. “I was listening to a conference talk by computer scientist Robin Milner, on the application of pi calculus to dynamic communication networks, when it occurred to me that molecular networks can have similar properties,” she explains. Following this up, she developed a method for describing and understanding the dynamic relationships between entities in a biological system (such as proteins in an interaction network) using this type of “process algebra.” “Regev started out as a young graduate student applying a novel and rather obscure computational methodology to a biological problem. This type of work has only very recently been recognised as a major part of systems biology,” says Brunak. The Overton Prize is awarded in memory of former ISCB director Chris Overton, who died prematurely in 2000; his research output was always innovative and thought-provoking, and it seems particularly fitting that this prize should go to a young researcher whose graduate studies were characterised by such an unexpected—and productive—interdisciplinary leap.Molecular Cell showed the transitional event that we had predicted,” she says. “That was great motivation!”After graduation, Regev moved to the US to take up her first independent position, at the Bauer Center for Genomics Research at Harvard University. “As a Bauer Fellow, I had five years' guaranteed money to start my own group, with no teaching or admin responsibilities,” she says. “It was research heaven.” There, her research interests switched to the use of probabilistic graphical models to reconstruct networks based on genomic and transcription data, using yeast as a model system. Her group, in collaboration with Amos Tanay and Ron Shamir, showed that while some DNA sequences involved in gene regulation are tightly conserved across even distantly related yeast species, other such sequences diverge, and used this to infer the evolutionary history of certain regulatory elements in yeast. “Our work was vindicated when a paper from an experimental group in Nature in December 2007, where it was also featured in that journal's Making the Paper section.In 2006, Regev took up a position as an assistant professor at MIT, where she is also a Core Member of the Broad Institute. She has extended her network models to a range of applications including the characterisation of genes that are co-expressed in a range of cancer types but not in normal cells, and studying gene duplication. And, once again, a chance meeting sparked a productive idea. “I was returning from a conference with a colleague, Jill Mesirov, who had been trying to study variation in the gene expression of the malaria parasite in different patients' blood cells,” she explains. “Mesirov's data came from Johanna Daily and Dyann Wirth, infectious disease specialists from Harvard, who suspected that variation in gene expression might explain some of the observed variation in the clinical course of the disease. I wondered whether there might be equivalence to my own classification of yeast gene expression patterns, and so it proved: the malaria samples could be classified into three groups, similar to states characteristic of active growth, a starvation response, and a stress response in yeast.” This work was published in This is not the first time that Regev's work has been recognised by the ISCB. During the last decade, her name has appeared on a prize-winning poster or paper abstract at ISMB no fewer than four times. The Overton award is the most prestigious of her career so far, but it is unlikely to be the last.Keynote lecturers, and which will also feature a Highlights Track, Special Sessions, Technical Demonstrations, and a unique “Visual Reflections on Science” exhibition, please visit the conference Web site at http://www.iscb.org/ismbeccb2008.For the full agenda and registration information for ISMB 2008, where these ISCB award winners will be joined by six other distinguished http://www.iscb.org/ssaa.shtml and http://www.iscb.org/overton.shtml, respectively.For a review of past ISCB Accomplishment by a Senior Scientist Award and Overton Prize winners, please see


The oldest of nine children in a family of modest means, he was aware of the constraints and his father’s toil in the fish-curing business, “My heart used to twist like a Turkish bagel as I watched him lift those weights and stir the herring with his frozen hands.”Chagall had little exposure to art during childhood, until one day, he saw a schoolmate draw a picture from a magazine. Ridiculed for his astonishment, he revolted, “It roused a hyena in me.” He started copying from magazines himself and showed early talent. Later, Russian icons, which he found “magical and unreal,” also provided inspiration. The family lived in Vitebsk, Byelorussia (now Belarus), then part of the Russian Empire. This small village community fueled his life’s work with honesty and charm, poetry and humor, lyricism and pure joy.Chagall’s studies began in 1906 under local artist Yehuda Pen. “I learned about Pen when I was riding on a tram. It was crossing the Cathedral Square and I saw a signboard―white letters on blue: ‘Artist Pen’s School.’ ‘What a cultured city is our Vitebsk’ I thought.” Soon he moved to St. Petersburg to join the Society of Art Supporters School, where he studied briefly under Nikolas Roerich. At the time, Jewish residents needed a permit to live in the city, so he was briefly jailed for violating this restriction. He continued under Léon Bakst at the Zvantseva School of Drawing and Painting.His reputation as an artist grew solid enough to earn him sponsorship to Paris in 1910, the heyday of modern art. Fauvism, with its emphasis on emotion and color, was still influential, and cubism, with its turn to representation from multiple points of view, was bursting onto the scene, led by Picasso and Braque. “I aspired to see with my own eyes what I had heard of from so far away …. The sun of Art then shone only on Paris.”He settled in the heart of the arts community, Montparnasse, and met avant-garde poets Blaise Cendrars and Guillaume Apollinaire and painters Robert Delaunay and Fernand Léger. He studied broadly and produced during these years some of his most famous village paintings. “In Paris, it seems to me I have found everything, but above all, the art of craftsmanship. I owe all that I have achieved to Paris, to France, whose nature, men, the very air, were the true school of my life and art.”His studio was in La Ruche (The Beehive), an artists’ colony. Amedeo Modigliani lived on the same floor. “I used to stand alone … in front of my easel in the wretched light of a paraffin lamp …. It was between those four walls that I wiped the dew from my eyes and became a painter.” The fauvists freed his use of color, and he learned from the cubists, though he never joined them: “Let them eat their fill of their square peas on their triangular tables.” Cendrars, who titled some of his paintings, wrote his own poetic portrait of Chagall: “He’s asleep/He’s awake/Right away he’s painting/He grabs a church and paints with the church/He grabs a cow and paints with the cow/With a sardine/With heads, hands, knives/He paints with an oxtail/….”Soon he was exhibiting at the Salon des Indépendants, and though his works were not selling well at this the height of abstract art, he espoused neither impressionism nor cubism. Instead, he used their influences to articulate his own unique style, a blend of formal structure, brilliant color, and fluid form. “For the cubists,” he wrote, “a painting was a surface covered with forms in a certain order. For me a painting is a surface covered with representations of things―objects, animals, human beings―in a certain order in which logic and illustration have no importance.”surnaturel , perhaps seeing in them the first signs of surrealism before he even coined the term. A poem he wrote about Chagall whom he mysteriously dubbed “Rotsoge,” captured the painter’s conflicted spirit―now avant-garde Paris, now the village: “Your scarlet face your biplane convertible into hydroplane/Your round house where a smoked herring swims.”When Apollinaire saw the paintings at Chagall’s studio in Montparnasse, he pronounced them tzimmes there. And my uncle loved walking the street with just a nightshirt to his body.” When at age 35 he finished writing his autobiography, My Life, it seemed he wrote it to explain his work.The whimsy, unreality, and sheer exuberance of his compositions would later attract the attention of surrealists, who enthusiastically claimed him as one of their own. Despite his influence on them, however, he did not share their inspiration from the subconscious, the world of dreams. He drew from his experiences, “You see, here is my whole biography: They used to find my grandpa on the roof, he loved eating After a very successful art show in 1914, Chagall went back to Vitebsk for a brief visit, which ended up lasting several years on account of World War I. In Vitebsk, he embraced the Bolshevik Revolution and was made commissioner of fine arts by the new Soviet government. He organized exhibitions and became Director of the Vitebsk Academy of Art. But with time, it became clear that neither his style nor his vision for society fit in. He moved to Moscow, where he painted theater murals and designed costumes and sets until he left Russia in 1922.Back in Paris André Breton offered him the approval of surrealists, “With Chagall alone, the metaphor made its triumphant return into modern painting.” But he resisted, “I want an art of the earth and not merely an art of the head.” He followed his own style, traveled widely, and ventured into multiple media . World War II forced him to flee France, this time to New York City. Three years after the end of the war, he returned to France, where he lived the rest of his life. His art career spanned more than 70 years. He left behind thousands of works, a legend in his own time.Painted a year after Chagall first went to Paris, I and the Village, on this month’s cover, integrates elements of cubism with his own vision of the world, “Lines, angles, triangles, squares, carried me far away to enchanting horizons.” A geometric structure frames a village scene with overlapping images: a green-faced man with a cap, his hand holding a flowering sprig, stares directly at a cow’s head. The cow stares back. The sun, the earth, and the moon in eclipse blend softly in the foreground. A peasant carries a scythe. A female fiddler floats upside down along with two houses from the row above. The village skyline crowns the horizon.“Cows, milkmaids, rooster, and provincial Russian architecture … are part of the environment from which I spring,” Chagall wrote, but individual parts assume roles and dimensions he created for them. “I fill up the empty space in my canvas as the structure of my picture requires with a body or an object according to my humor.” He explains, “In the large cow’s head…I made a small cow and woman milking visible through its muzzle because I needed that sort of form, there, for my composition.”I and the Village seems Chagall’s personal notion of the community, a cosmic one , made intimate and poetic, jewel-colored, folksy, with music, sparkle, and humor. Two main characters, man and beast stand face to face at the entrance, deliberately linked with a line, eye to eye.Barnyard animals, cows or goats, frequent Chagall’s work, wandering freely, often airborne along with humans, unconstrained by reality. Here, they share equivalent status across the planets in the entrance of the village. In a playful standoff, each claims the “I,” seeing alternatingly fences and tethers, limits and yoke; milk and honey, highways and byways. Though wide-eyed, they seem oblivious to what weighs all of us down to earth: infection and consequent illness and death, shared lavishly in the village. From the narrow perspective of “us” or “them,” zoonotic infections are not well understood. Their solution requires the total picture, from the human and the animal point of view. Because each “I” sees a different village.


Emerging Infectious Diseases. They studied home foreclosure and West Nile virus (WNV) incidence in the Bakersfield, California, area for 2006 and 2007 and found a parallel rise in both. Notices of delinquency rose 300%, soaring from 500 in the middle of 2006 to 1,500 in the middle of 2007. In the same period, documented human WNV cases rose 276%, peaking at 140.Criminal, civil, and journalistic investigators “follow the money” to identify the culprit of a crime. Public health detectives sometimes follow suit, since income is a well-known indicator of relative healthiness. In a new twist on this association, the worldwide financial crisis appears to be affecting human health in some settings, according to a team of researchers reporting in the November 2008 issue of The rise in WNV cases was a surprise, because the usual predictors—temperature, moisture, and infection rate and population of WNV hosts such as birds and vectors such as mosquitoes—initially pointed to a lower-risk period. The authors attribute the rise in WNV in part to a high number of abandoned homes with swimming pools, hot tubs, and ornamental ponds, many of which became breeding grounds for mosquitoes.The correlation between abandoned water features and mosquito-borne diseases has been strongly suspected, but there had been little hard proof of the link. States with high foreclosure rates such as Arizona, California, and Florida are working to deal with problem pools. However, Rebecca Shultz, the Arthropod-borne Disease Surveillance Coordinator for the Florida Department of Health, points out that the California findings don’t currently apply to Florida because the latter state has had virtually no WNV for the past 3 years. One distinguishing factor may be that Florida’s surge in abandoned pools doesn’t add significantly to the total breeding area for mosquitoes, as the state is already naturally laced with water bodies, even during long-term drought.Another factor may be a shift in California’s bird host makeup. William Reisen, the California study’s lead author and a research entomologist at the Center for Vectorborne Diseases at the University of California, Davis, says that persistent drought, WNV, and other diseases such as avian pox virus had contributed to the decimation of two important local WNV hosts, western scrub jays and house finches. But a third competent host, house sparrows, wasn’t hit as hard and rebounded strongly during 2007 with an abundance of young birds who are vulnerable to WNV.As a followup to the study, Reisen’s team is working with the National Aeronautics and Space Administration, Google Earth, and four mosquito control districts representing diverse California settings to study abandoned pools and ponds, and to correlate their observed mosquito-breeding status with satellite images of the water bodies. Once this initial “ground-truthing” has been accomplished, satellite images themselves can provide a quick way to determine problem areas and circumvent typical barriers to effective surveillance such as climbing over fences around pools or relying on neighbors to report problems. If this works for California, Reisen anticipates the methodology could then be available for other states.Although Florida isn’t currently in the same boat as California, Shultz says she is looking forward to having this new tool: “Any time you can speed up the timeline of getting data in, it’s very helpful.”The interactions of natural and human forces in WNV and other emerging infectious diseases are complex, and much remains unknown. But Reisen says his team’s study, though limited in a number of ways, illuminates one small example of why such diseases are on the rise: the foreclosures, he says, are “just one aspect of anthropogenic factors altering the ecosystem.”


The emergence of the novel A/H1N1 virus has made pandemic preparedness a crucial issue for public health worldwide. Although the epidemiological aspects of the three 20th century influenza pandemics have been widely investigated, little is known about population behaviour in a pandemic situation. Such knowledge is however critical, notably for predicting population compliance with non pharmaceutical interventions. This paper reviews the relevant scientific literature for the 1918-1920, 1957-1958, 1969-1969 influenza epidemics and the 2003 SARS outbreak. Although the evidence base of most non pharmaceutical interventions (NPIs) and personal protection measures is debated, it appears on the basis of past experience that NPIs implemented the most systematically, the earliest, and for the longest time could reduce overall mortality rates and spread out epidemic peaks. Adequate, transparent, and targeted communication on the part of public health authorities would be also of crucial importance in the event of a serious influenza pandemic. The emergence of the novel A/H1N1 virus has made pandemic preparedness a crucial issue for public health worldwide. Knowledge of past pandemics is of substantial help when planning for a future one a population behavioural survey in four European countries (on-going), and a literature search on population behavioural responses to past influenza pandemics and to the SARS outbreak. This paper reports and summarizes the results of the literature search.“Population behaviour” was defined as the response to and the social consequences of an influenza pandemic and SARS on the part of 1) the public health authorities, 2) health care workers, and 3) the general population. The present study is based on: 1) a systematic search in the American National Library of Medicine (PubMed) using the following MeSH terms: “Influenza AND disease outbreaks AND history”, “Influenza AND disease outbreaks AND public health response”, “Influenza AND disease outbreaks AND social behavior”, “Influenza AND disease outbreaks AND absenteeism”, “Influenza AND disease outbreaks AND travel”, “Cross-infection AND disease outbreaks AND influenza”, “SARS AND disease outbreaks AND history”, “SARS AND disease outbreaks AND social behavior”, “SARS AND disease outbreaks AND travel”, “ SARS AND disease outbreaks AND absenteeism”, “SARS AND disease outbreaks AND public health practice”, “Cross-infection AND disease outbreaks AND SARS”. Since there was no MESH term corresponding to school closure, we conducted a simple search combining “school closure” with both “influenza” and “SARS”; 2) a general Internet search using the terms: “Non pharmaceutical interventions AND pandemic planning”, “Absenteeism AND pandemic flu”, “Pandemic preparedness AND NGOs”, “Panic AND pandemic influenza”, “Pandemic AND historical data”, “Pandemic influenza history”, “Eyewitness accounts AND Spanish influenza”, “Pandemic history books”, “Population compliance AND pandemic influenza”, and 3) anecdotal information found in the Lancet, JAMA, the Times, and le Figaro. All literature that did not include direct or indirect elements relevant to behavioral response as defined above was excluded from the analysis.Exclusive of anecdotal information and articles written in unknown foreign language (for the authors), a total of 124 relevant sources  were located, covering the following topics: absenteeism, border screening and quarantine, community planning, disease and social class, disease spread, effects on the economy, ethical considerations, health seeking behavior, hospital preparedness, infection control in hospitals, long term effects of influenza, personal protection measures, psychological aspects of epidemics, role of health care workers, role of the media, role of pharmacists, school closure, stigma, surveillance and reporting. The majority of data related to the 1918-1920 pandemic. Almost no information was identified on “population behaviour” during the two subsequent pandemics. Information on the SARS outbreak concerned mostly infection containment. Finally, prospective studies in view of a future pandemic included surveys, modeling, analyses, and simulation exercises.1. 1918-19201.1 Response of the public health authoritiesIn 1918, the public health authorities rapidly recognized the influenza outbreaks as a pandemic similar to that having occurred in 1889-1890 and consequently expected three epidemic waves: the first mild, the second virulent, and the third declining The prevention measures introduced  were largely the same as those considered today: school closure, restrictions on public gatherings, isolation and quarantine, health education, and personal hygiene . The American Association of Public Health considered face masks the best prophylaxis after isolation, but recognized the difficulty of using them on a broad scale Regarding the effectiveness of NPIs, the most systematic study identified by the literature search examined 43 cities across the United States with markedly different incidence and mortality ratesNPIs were not successful in all countries. In Italy, a recent study found no difference in mortality rates between those cities which implemented NPIs and those that did not 1.2 Consequences of the pandemic on the general populationRegarding the effectiveness of NPIs, one of the difficulties was public compliance. Compliance was seen to wane with time (when the preliminary wave of fear declined), for environmental reasons (keeping people indoors on hot nights) Conflicting recommendations from various national and local authorities combined with widespread absenteeism and insufficient medical staff owing to military obligations (up to 50% in Great Britain) Several studies have cast doubt on the generalized belief that the 1918 pandemic struck evenly across society  if not across the world. Convincing evidence that poorer social groups suffered greater mortality has been provided for the United States 2. 1957-1958, 1968-1969th century pandemics. One study conducted in the United States found that in 1957 influenza strains had spread mostly through schools, contrary to 1968  A total of three relevant articles was identified for the two other 203. Severe Acute Respiratory Syndrome (SARS)The containment of SARS, both on the national and international levels, was exemplary. Nevertheless, a certain number of hindrances and complexities were subsequently identified which can be of use when planning for an influenza pandemic.3.1 Response of the public health authoritiesOne of the first measures to be taken to limit the outbreak was the screening of persons returning from infected countries. In Canada, the health authorities distributed leaflets to passengers in several languages, introduced compulsory screening (interviews), and installed infrathermal scanning machines. But, according to one author, screening effectiveness was necessarily limited by the fact that travel time to Canada from any point in the world is less than twenty-four hours, thus making the detection of a case during incubation highly unlikely Quarantine was also widely used. In Taiwan, 150,000 people were quarantined of whom only 24 were subsequently found to have laboratory-confirmed SARS. Quarantine proved to be effective in improving onset-to-diagnosis time and limiting infection In Hong Kong, mass education regarding SARS appears to have been relatively effective  3.2 SARS and health care workersMost health care workers (HCWs) involved in the treatment of SARS patients found themselves in a totally novel situation: their job had suddenly become potentially life-threatening and many were cut off from their usual social environment (either due to their own isolation or fear of contagion on the part of friends and family). The compliance of HCWs was critical in the effort to prevent nosocomial spread and “leakage” of infection back into the general population. Beyond the actual hospital building characteristics (e.g. self-contained emergency room), the importance of developing and adhering to infection control programmes has been widely stressed4. Current surveys and modeling in view of a “future” influenza pandemic4.1 Possible responses on the part of public health authoritiesconcomitant use of NPIs could be very helpful in delaying the temporal effects of an epidemic by reducing peak attack rates and allowing time for preventive and therapeutic interventions as well as reducing the burden on health care systems A study of NPIs based on the recent literature and “expert opinion” concluded that there are very few high quality studies to inform the evidence base for NPIs (Table 1). It is generally accepted that no one NPI implemented on its own would be effective in lessening the spread of disease in a pandemic situation, with the possible exception of early isolation of cases and voluntary quarantine Table 1. NPIs recommended on the basis of a review of the literature and expert meeting , influenza spread rapidly, as it did in 1957 and in 1968, when the volume of air traffic was not comparable to what it is today. And in 1968, it appears that influenza spread quickly and extensively by international air travel Border screening is generally not considered to be an efficacious prevention measure, given influenza incubation periods, the need for highly sensitive tests, and the expense of the procedure, although some feel that it might “reassure” public opinion in a pandemic situation School closure, on the other hand, is one of the first containment measures advocated by national pandemic preparedness plans, and has been employed in certain countries in the wake of the influenza outbreaks in Mexico and the United States. The main arguments in favour of school closure are based on the assumption that children are major influenza spreaders. Schoolchildren have indeed been shown to be important vectors of seasonal influenza 4.2 Possible consequences of a “future” pandemic on the general populationA distinction should be made between “behavioral” and “emotional” implications in a pandemic situation. Population behavioral reactions include panic, non compliance, resistance to travel restrictions, breaking of quarantine and isolation, and civil unrest, whereas emotional responses to a severe epidemic could lead to increased anxiety, depression, suicide rates, traumatic stress reactions, and complicated grief Regarding population behaviour, a nation-wide survey conducted in the United States in 2006 revealed that only 41% of the population knew what “pandemic” meant, 33% had heard of it without understanding the concept, and 25% had never heard it. A surprising 94% of the population stated that they would be able to stay home for 7-10 days if ill themselves, and 85% - if a household member were sick. 85% also believed that they could keep their child from attending public gatherings. But high percentages of single adults, chronically ill persons, low income groups, and ethnic minorities stated that they would have no one to look after them in case of illness Absenteeism due to childcare and personal illness is the main preoccupation when considering the economic and social consequences of a pandemic. Various studies have found that anywhere between 25% and 50% of staff would be absent from work at one point in time during a pandemic influenza outbreak, but not all the time st year medical students considered it “professionally acceptable” for HCWs to abandon their workplace during an influenza pandemic and a further 19% were “unsure” Predicting absenteeism levels of HCWs is clearly a crucial issue for pandemic preparedness. A UK survey found that the profession likely to be the worst affected by school closure would be precisely the health sector, given the impossibility for HCWs to work from home and the fact that the majority of this workforce is made up of women (the main caregivers in society). According to this survey, absenteeism for childcare and due to personal illness at the peak of the epidemic could lead to a 45% reduction in HCWs' attendance The financial sector has carried out various simulation exercises in order to address its capability to cope with a pandemic Table 2. Main lessons learned during a simulation exercise concerning a serious pandemic influenza outbreak and business continuity (according to )st century, people can find out what measures are being taken in other countries and this could lead to increased public demand, warranted or unwarranted criticism of public health policies, and conflicting perceptions of “fairness” of interventions and resource allocation. The importance of transparency on the part of public authorities has been clearly illustrated by a series of health “crises” in Europe over the past quarter of a century . Cleary, public trust has been influenced over the years by how authorities deal with health problems and emergencies and, in the event of a serious influenza pandemic, appropriate communication tailored to specific groups will be critical to disease control (Table 3). If we are to prepare for the worst while hoping for the best, the 1918 experience should be considered when planning for a “future” pandemic. Major changes since the deadly 1918 pandemic include our capacity to detect cases rapidly, improved health care, access to care, targeted pharmaceuticals, and overall coordination. Yet we still face major difficulties in predicting the transmission dynamics of influenza, its local impact, and population compliance with prophylactic measures. Today, as then, the authorities will seek by various means to mitigate panic in the interest of disease control. Today, as then, shortages of HCWs – for a variety of reasons – are to be expected. Today, as then, business profiteering could occur, especially on the web . Public behaviour is likely to be similar in some respects (waning compliance with prevention measures as fear declines), but it is difficult to determine the respective effects on the population of the on-going “war effort” (in 1918) and a heightened perception of personal health and exposure to risk (today). Suboptimal adherence to prevention measures as a function of risk perception has been noted, or at least discussed, with regard to diseases such as HIV-AIDS Table 3. Ethical issues and possible responses , used MeSH terms (which are not necessarily exhaustive) and by definition our findings suffered from English-language publication bias. We did not have access to unpublished material, such as doctoral dissertations, public or private surveys. We were not able to consider the economic consequences of NPIs in a future pandemic scenario, since data was lacking. Finally, we did not compare national pandemic preparedness plans (in developed countries) with regard to expected population behaviour and NPIs. A thorough search and comparison of a selection of the most important daily newspapers for the epidemics considered would also undoubtedly have revealed precious information, at least regarding media-perceived public reaction. Despite these gaps in information, we believe that this review is one of the first to gather and analyze data on population behaviour in pandemic or serious outbreak scenarios over the past hundred years.What practical lessons can be drawn on the basis of this literature search?probably have the greatest prevention effect in the absence of an efficacious vaccine. Two, population adherence to public health measures and messages might well be high during the initial phase of an epidemic perceived as dangerous, but then decrease with time. Three, enhancement of infection control programmes in hospitals is necessary for preparedness. Finally, adequate and transparent information on the part of heath care authorities and in collaboration with the media, business, and organizations will be paramount for disease control and containment.From a historical perspective, four main conclusions stand out. One, non pharmaceutical measures  – regardless of their “evidence base” – implemented the most systematically and for the longest time would The authors declare no conflict of interestThe corresponding author declares she has had full access to the data used for this literature search.This literature search was funded by the FLUMODCONT project .We grateful to Antonella Latanzi  for her support in conducting this study and Cécile Viboud  for her technical guidance.


We present the results of an individual agent-based model of antibiotic resistance in bacteria. Our model examines antibiotic resistance when two strategies exist: “producers”–who secrete a substance that breaks down antibiotics–and nonproducers (“cheats”) who do not secrete, or carry the machinery associated with secretion. The model allows for populations of up to 10,000, in which bacteria are affected by their nearest neighbors, and we assume cheaters die when there are no producers in their neighborhood. Each of 10,000 slots on our grid (a torus) could be occupied by a producer or a nonproducer, or could (temporarily) be unoccupied. The most surprising and dramatic result we uncovered is that when producers and nonproducers coexist at equilibrium, nonproducers are almost always found on the edges of clusters of producers. Staphylococcus aureus, Pseudomonas fluorescens, Pseudomonas aeruginosa, Myxococcus xanthus, Saccharomyces cerevisiae and Escherichia coli. In addition, theoreticians have actively debated the role of individual, kin, group, and frequency-dependent selection in explaining the results of these experiments The evolution of traits that may benefit others, as well as self, has long been an interest of evolutionary biologists E.coli. In two earlier papers, we examined the evolution of “producers” (who secrete a substance that breaks down antibiotics) and nonproducers (“cheats”) who do not secrete, or carry the machinery associated with secretion. Our prior models examined the evolution of these strategies in a single, very large population Using both theoretical and empirical tools, we have been examining the evolution of group-beneficial traits in the context of bacterial antibiotic resistance in Here, we examine the evolution of producers and nonproducers using an individual agent-based model. The model allows for populations of up to10,000, in which bacteria are affected by their nearest neighbors. Each of the 10,000 slots on our grid (a torus) could be occupied by a producer or a nonproducer, or could (temporarily) be unoccupied. Our empirical work suggests that this agent-based model may best mimic the dynamics of bacterial interactions in the context of shared antibiotic resistance. For example, our experimental work has found that when β-lactamase is produced to break down antibiotics, it is tethered to the producer cell, and hence primarily affects the producer's nearest neighbors. Our agent-based model captures this dynamic in ways that prior models have not.We consider two genotypes, labeled producers and nonproducers. Producers create a substance that provides them with a benefit and provides benefits to other group members as well, while nonproducers do not produce such a substance. In this model the “substances” we focus on are enzymes, such as β-lactamase, that break down β-lactam antibiotics . In terms of bacterial antibiotic resistance, producers will possess a gene  that codes for an antibiotic resistance mechanism that protects them from damage due to antibiotics. Plasmid possession carries a cost, in that cellular resources are required for plasmid replication and maintenance In our model, the benefit (B) associated with β-lactamase ranged from 0 to 1. Producers always received this benefit. Because β-lactamase may be “tethered” to the outside of a cell, we created a variable called “help” that measures the proportional benefit that cells near a producer receive, as a result of the β-lactamase tethered to that producer . Producers pay a cost (0<C<1) associated with β-lactamase production B−C+(number of producers in neighborhood x B x help)The fitness of the producers = The fitness of the nonproducers0; if no producers are in neighborhood = ornumber of producers in neighborhood x B x help; if one or more producers are in neighborhood. = We used NetLogo simulation software or empty slots, that slot was empty in the next generation.Neighborhood size was set at eight individuals–the so-called “Moore neighborhood”–corresponding to the eight slots that could be reached in a single move of a chess king Although any stochastic simulation will eventually settle at a homogenous absorbing state We examined thirty B/C scenarios from rations of 2∶1 down to 0.5∶1, as well as six different values for “help.” When B>C, producers went to fixation very quickly in our model. When C>B, we found, not unexpectedly, that increasing the B/C ratio increased the equilibrial frequency of producers. In addition, increasing the value of “help” increased the frequency of producers. Our most novel, and potentially important, finding was that if C>B, and producers and nonproducers coexisted at equilibrium, nonproducers were almost always found on the edge (boundary) of clusters of producers; more specifically, nonproducers were found between clusters of producers and areas of open space . The results of our model are in agreement with some general findings from this work: for example, as the B/C ratio increases, cooperation increases. Our model uncovered an interesting, novel spatial patterning for producers and nonproducers, wherein nonproducers–the equivalent of cheats in our simulations–were almost always found on the boundary between clusters of producers and empty (unoccupied) slots. This was in part a result of the strong frequency-dependent nature of the payoffs in the model, especially the harsh payoff when cheaters were surrounded by other cheaters. Though the position of producers, nonproducers and empty slots moved around through time, the “cheaters-on-the-edge” phenomenon moved with it. This dramatic spatial pattern appears to be the result of the following dynamics: when surrounded by other nonproducers or by empty space, nonproducers in our model die (due to antibiotics). What that means is that clusters of nonproducers perish, and nonproducers cannot survive in the middle of “clusters” of empty slots. When nonproducers find themselves in the midst of clusters of producers, they do poorly because of the dynamics of competition at the local scale. For example, consider the case of a nonproducer whose Moore neighbors are all producers. The relative fitness of that nonproducer is higher than any of its producer neighbors, but the particular strategy that will fill that nonproducer's slot in the next generation is a function of the fitness of producers and nonproducers in that Moore neighborhood Why then do nonproducers survive on the moving boundaries between clusters of producers and areas of empty space? In these areas, nonproducers can often fill empty slots because they are closer to those empty slots than producers (who cluster with each other). But, nonproducers cannot continue to fill further empty slots because once they begin to cluster in formerly empty space, they die in the presence of antibiotics, when no producers are nearby. This introduces a temporal component to the results, wherein nonproducers appear to “chase” empty slots, and producers appear to chase the nonproducers.The fact that producers clustered together quickly in our simulations also helps explain why increasing the value of “help” – the proportional benefit that cells near producers receive–increased the frequency of producers. Clustering created a situation in which producers were most often aiding others producers, and this, in conjunction with the phenomena outlined above, will allow us to better understand why providing greater levels of help differentially aided producers.We recognize that our model examines only two strategies and that costs and benefits themselves may evolve: more work is needed on these fronts. Nevertheless, it is our hope that these results will spur empirical researchers working on group-beneficial traits in bacterial model systems to search for spatial and temporal patterns similar to those we have observed in our agent-based simulations. In terms of medical implications, because nonproducers in our model were sensitive to antibiotics, and were often found between empty spaces and producers, targeting such areas with antibiotic infusions may be worth considering.


American Sociological Review, 48, 781–795.) has termed “boundary work”, i.e., to delegitimize the tests as outside proper medicine and science. Yet, they legitimated them, though in a different way, by defining them as lifestyle, and we contend that the transformation of the boundaries of science into a creation of such hybrid or compromise categories is symptomatic of current historical times. Social scientists studying medicine have referred to the emergence of “lifestyle” products. This article contributes to this literature by examining the historical, regulatory and marketing processes through which certain goods and services become defined this way.Genomics researchers and policy makers have accused nutrigenetic testing companies—which provide DNA-based nutritional advice online—of misleading the public. The UK and USA regulation of the tests has hinged on whether they are classed as “medical” devices, and alternative regulatory categories for “lifestyle” and less-serious genetic tests have been proposed. This article presents the findings of a qualitative thematic analysis of the webpages of nine nutrigenetic testing companies. We argue that the companies, mirroring and negotiating the regulatory debates, were creating a new social space for products between medicine and consumer culture. This space was articulated through three themes: (i) how “genes” and tests were framed, (ii) how the individual was imagined vis a vis health information, and (iii) the advice and treatments offered. The themes mapped onto four frames or models for genetic testing: (i) clinical genetics, (ii) medicine, (iii) intermediate, and (iv) lifestyle. We suggest that the genomics researchers and policy makers appeared to perform what Gieryn . Boundary-work and the demarcation of science from non-science: strains and interests in professional ideologies of scientists.  Genetic testing has traditionally been managed by clinical geneticists concerned with rare and often incurable disorders, such as Huntington's disease, caused by a single gene. The test results have informed sensitive reproductive decisions, which might be facilitated by specialist counselling.The recent major public, private and charitable investment in genomic research—including vast projects, such as the Human Genome Project and the UK Biobank—has been justified by the promise that genetic tests will benefit the population at large. Both UK  and USA A number of small biotech companies have gone further and sold genetic tests – such as paternity and ancestry tests, tests for susceptibilities for illness or addiction or whole genome scans – online. In this article, we focus on a subset of these companies, which offer nutrigenetic tests, i.e., a service whereby customers send DNA samples (mouth swab) and receive, often via mail, advice on diets and supplements based on testing of a few gene variants. Following the sociology of technology literature , we examThe Killer in Me, which featured four celebrities taking a test offered by Genetic Health and claimed to “open a window not just on their lives but potentially their deaths”  programme  deaths” .Nature Genetics that the science of using genetics to enhance healthy lifestyle “holds great promise” but was “not ready for prime time” . In 2006 in hearings in front of Senate's Special Committee on Aging, following the damning GAO report, the issue became whether nutrigenetic tests were medical devices, and if so, which risk classification they should belong to. As stated by Dr. Steve Gutman from FDA during the hearings:… genetic information to consumers concerning their nutritional wellbeing, contributing to their health and wellness. Sciona is not involved in diagnostic or disease-related services or information .In response Rosalynn Gill-Garrison, Sciona's Chief Technology Office testified in the same hearings that the company's services were not, indeed, medical but offered:… an alternative regulatory mechanism be created to tests, such as ‘lifestyle’ tests, which are currently not regulated as they fall outside the scope of the IVDD directive : 16.In the UK, the regulation of genetic tests was governed by the European Union's In Vitro Diagnostic Devices (IVDD) Directive, which was implemented nationally by the Medicines and Healthcare Products Regulatory Agency (MHRA). Similar to the USA situation, the regulation hinged on the question of whether nutrigenetic tests would fall under the ambit of the IVDD Directive as “devices used for medical purposes,” and if so how their risk would be classified. The Human Genetics Commission (HGC) – an advisory body consisting of individuals with a genetics interest, such as clinical geneticists, genetic counselors, scientists, patient and industry representatives and members of public, such as science journalists – had been pushing for the regulation of direct-to-consumer (DTC) genetic testing since 2003 . In its Due to legal technicalities and the prevailing view among the genomics community that not all genetic tests were alike  in June 2008).As stated by an industry representative during pilot fieldwork in 2006, in this situation the companies needed to choose a strategy between developing products more akin to “diet drinks and skin creams,” which customers do not necessarily expect to work, or more serious “cardiovascular products,” which would need to be backed up by more extensive research. Different companies were choosing slightly different strategies. For example, an industry representative stated that nutrigenetic tests “should” be classed as medical devices and regulated in a similar manner to disease risk and pharmacogenetic tests. However, the representative acknowledged that …In this statement, the industry representative was also doing boundary work  in an atIn this article, we will analyse the webpages of nutrigenetic testing companies as a case study of the production of a new marketing and regulatory category between medicine and consumer culture. We will also pay attention to how different companies shape the category differently.The undertakings of the nutrigenetic testing companies may be fascinating per se, but we were interested in them because they were symptomatic of broader transformation in medicine. They also highlighted a few rarely discussed or conceptualised features in this transformation.As already discussed, the efforts of representatives of public policy and genomic research to construct a boundary  between Medical sociologists have made sense of current, historical transformations in medicine with terms such as biomedicalisation  and infoNutrigenetic testing is similar to these cases in that it biomedicalises an everyday phenomenon – eating – by associating it with a molecular underpinning and specific diets or dietary products. The contribution of our nutrigenetics case study to this literature is that it highlights how biomedicalisation and attendant privatisation and commodification happened through the creation of a new marketing and regulatory space for “lifestyle” products between medicine and consumer culture. The casual use of the term “lifestyle” or “enhancement” in relation to nutrigenetic tests is common not only in regulatory texts but also in social science research literature e.g.  and is aTo explore how nutrigenetic testing companies were shaping the technology amidst regulatory and public debates, we analysed their webpages, on which they marketed and often directly sold the tests. We analysed the webpages of all companies marketing nutrigenetic tests on the Internet in 2007 and 2008. The sample is complete to the best of our knowledge, given the difficulty of tracking down frequently changing websites. The companies analysed were: Genelex (USA), Genovations/Genova Diagnostics (USA), Genetic Health (UK), Interleukin Genetics/Quixtar (USA), Market America (USA), Nutrigen (USA), Salugen (USA), Sciona , and Suracell (USA).The forces behind nutrigenetic testing companies included scientists; for example, one of the managers of Genetic Health, Dr. Paul Jenkins was a Reader in endocrinological oncology at the University of London. Many of the companies had complex connections with the consumer industry. The largest investor in Sciona was DSM, specialising in nutrition, pharmaceuticals, plastics and chemical products . NutrigeTo provide an overview of the products sold by the nutrigenetic testing companies, we have described in The webpages of the companies were multimodal  and hypeWe first printed a selection of the companies' webpages in 2007. Three authors  read the material and made note of frequent themes and images. We followed the principle of constant comparative method , which sWe then undertook further analysis of how different companies gave the themes slightly different spins, clustering into a few “frames,” following Three prominent themes emerged from the analysis of the companies' websites: (i) the nature of genes and the tests, (ii) the role of the individual vis a vis genetic information, and (iii) the advice and treatments offered. The companies articulated the three themes slightly differently, framing their products as “lifestyle,” “medicine,” or in-between the two (“intermediate”). Based on this observation, and our knowledge of the controversies around the tests, we constructed a stratified classification scheme for genetic tests—ranging from clinical genetics through to lifestyle genetics—which was taking shape on the webpages and in the debates. We located the companies' services and promotional strategies within this scheme see . In whatCan you tell me if I carry the genes for a serious illness?No. The Gene SNP DNA Screening Analysis is not a test for inherited disorders or inherited predisposition to disease. We do not screen for disorders caused by a defect in a single gene, such as Huntington's disease, cystic fibrosis or sickle cell anemia. .On their webpages, many nutrigenetic testing companies explicitly distanced their services from clinical genetic testing:Through such statements, the nutrigenetic testing companies distinguished their services from clinical genetic tests for disorders “caused” by a “single gene” and perceived to be riddled with ethical conundrums. In so doing, they mobilized the distinction frequently underlined in genomics research  and reguOptimize the health of your skin and bones; heart and mind by optimizing your personal diet and supplement intake. Genetic testing combined with a lifestyle assessment, provide you with a scientifically based, personal blueprint for optimizing health .When it came to defining the exact nature of the nutrigenetic tests, the companies had carefully crafted slightly different descriptions. Some companies  went to great lengths to avoid associations between their services and diagnosis or prediction of disease:The choice of the catchphrase, “optimize health,” reflected the regulatory debates, discussed previously, seeking to frame the tests as not “medical devices” but lifestyle. Further, the references to “health of your skin and bones,” did not bring into mind avoiding illness but enhancing beauty and fitness or strength. The combination of words “heart and mind” in relation to health does not immediately evoke the physical organ heart but ambiguous mental and physical wellbeing. One only needs to imagine how different the statements would read if words, such as “osteoporosis” or “cardiovascular disease,” were used. This illustrates how the “lifestyle” frame was created not just by avoiding disease-related claims with legal consequences but through consistent clues that suggested the tests were not serious medical devices but ambivalent wellness products see : 41–44.nutritional gene therapy by analyzing a person's DNA to customize their nutritional supplement pill ingredients .2005—Salugen pioneers Some companies, such as Salugen, combined catchwords associated with medicine and those associated with lifestyle or consumer culture, which is why we have termed their framing “intermediate.” Often times the catchphrases producing the intermediate frame were contradictory or even odd. An example is Salugen's description of the “timeline” of genetics innovations from Gregory Mendel and Watson and Crick until the initiation of the Human Genome Project in 1986 and…The italicized catchword here is inherently contradictory. The word “nutrional” referred to nutrients and eating, i.e., lifestyle or consumer culture. “Gene therapy” generally refers to a distinctly serious and experimental technology of modifying “defective genes” into healthy ones and has been, largely unsuccessfully, used to treat life-threatening conditions, such as forms of human immunodeficiency. Combining these words created a confusion as well as suggested that nutritional therapies may modify genes, i.e., that genes are not fixed. The convoluted term “nutritional supplement pill ingredients” is similarly contradictory, “nutritional” and “ingredients” often associated with food, i.e., consumer culture, “supplements” with lifestyle or wellness products and “pills” with medicine, but in a colloquial sense. This statement illustrates how the intermediate frame frequently mixed lifestyle and medical frames, producing intentionally and sometimes clumsily confusing definitions and statements.Some nutrigenetic testing companies  framed their services as akin to medicine, also spelling out the catchwords disease and prediction.•Earlier, more effective preventive interventions-years before disease develops;•Precise, customized therapies that truly address each individual's needs;•Improved clinical insight into patients with treatment-resistant “chronic” conditions .Our predictive genomic profiles assess genetic variations in each person that, when combined with modifiable factors in the environment, may increase disease risk. This empowers physicians and patients to realize:In this paragraph, Genovations indicated it assessed “disease risk,” which could signal to regulators that it was selling medical devices. It also used clinical words, such as physicians, patients, interventions, treatments and chronic conditions, throughout the text. Even if the statement did not say much concrete about the company's tests or treatments, the ubiquitous clinical vocabulary framed the services as serious or more like “medicine” rather than consumer culture.The three frames  were also created through the use of visuals and colours. In 2007, Sciona's frontpage featured three images on white background: one of a youngish smiling couple, against a green, leafy background, one of gleaming sweet peppers and one of a scientist in white suit and goggles peering into a microscope. These stock photographs sought to associate Sciona with lifestyle  and science. Salugen's frontpage in 2008 featured a large photograph of an extended family, sitting on a shore in informal summer-clothes. The image showed their bodies from the neck down (as if to protect anonymity) and next to each person a caption stated, for example, “predisposed susceptibility to diabetes.” Whilst the clothing of the people and the setting communicated informality, the captions created an ominous sense of illnesses passed on in the family. The frontpage of the UK company Genetic Health had a white background with light green accents and featured a small image of a stethoscope on the side and a gleaming lime in the company banner. Whilst the stethoscope and the airy and rather formal and professional layout framed the company as “medical,” the image of the lime and light green softened this frame, communicating lifestyle or wellness.Overall, the nutrigenetic testing companies dissociated themselves from clinical genetic tests for genes that “cause” disease. They were creating new frames or models for genetic tests as either lifestyle or less-serious medicine or somewhere between the two. The companies created these categories not only through explicit statements about not being medicine but consistent framing of their tests as more informal than medical devices through rhetoric, images and colour-schemes on their webpages.Whether you choose to “see” your genes or not, they are always there … By choosing to look at them, you are giving yourself the opportunity to do something about them. In this way, you can more actively—and more accurately—promote your health .Another prominent feature of the webpages was the way in which they addressed their customers as an individual, who should take personal charge of her/his wellbeing:This statement depicted the customers of the tests as individuals who should acquire personalised, genetic information to improve their health or prevent disease. This depiction reiterated and was supported by the ubiquitous, contemporary individualist or neo-liberal preventive public health agenda—of which preventive genomics forms a part—according to which individuals should improve their personal behaviour to prevent common diseases e.g. .For each of the health categories, your current position on the MyCellf Position Map-identified by the icon “You Are Here”-is plotted by the combination of your Gene Assessment (which cannot change) and your current Diet and Lifestyle Assessment . Your optimal health goal is identified by the “Your Goal” icon .All companies depicted their customers as active health-seekers, but they differed in terms of how they configured the users of their services and how they delivered those services .The companies framing their products as in-between medicine and consumer culture (“intermediate”), such as Suracell, Salugen and Nutrigen, framed their customers vis a vis their services slightly differently. They emphasized that they offered the tests in quasi-medical settings, such as spas and wellness centers, aided by professionals of more or less ambiguous qualifications, such as “registered nutritionists” (Nutrigen) or trained lifestyle or aging “coaches” (Suracell):The references to spas, wellness, stress reduction and favorable atmosphere configured the customer as being served in a pleasurable setting or being “pampered.” The attention provided for the customer was depicted as professional but not medical with references to expertise, training and background in stress reduction and age management. Yet, Suracell, Nutrigen and Salugen all at some point between 2006 and 2007 sold their tests direct online. So, the references to relaxation and anti-aging also configured the customer as purchasing online products associated with beauty and health rather than medicine. This notion was reinforced by images, such as Salugen's large depiction of a young, nude woman immersed in water (on its SpaGen page), symbolizing rejuvenation and sensuality and frequently employed in advertising for personal hygiene and cosmetic products.Preventive genetic diagnostics helps to explain why individuals are affected differently by the same environmental factors. Most importantly, it enables the physician to select suitable measures for his patient tailored to his individual genetic needs .Companies framing their tests as predicting disease risk  indicated on their webpages that their tests were available through a physician. For example:In this description, users were configured as “patients” in a traditional doctor-patient relationship, where the expert makes the decisions in a paternalistic fashion, such as “selects suitable measures.” The users were also addressed indirectly, as the pages were formally addressed to physicians (“doctors area”) communicating that the company was selling the tests to healthcare professionals. The expectation of a clinical relationship was supported by images of stethoscopes  or of a middle-aged, male doctor reading notes (Nutrigen). Regardless of these depictions, Genetic Health offered its nutrigenetic tests direct online. On its webpage, the company noted it can “email [the test-]report directly to you” but “recommended” that “one of our doctors go through it with you,” “on the telephone” or in “our clinic” . Genetic Health, thus, did not necessarily configure its customer as a patient in a clinic but as someone purchasing a medical-like service online but backed up with clinical support, if required, via phone or face-to-face.The online sale of nutrigenetic tests was often raised in regulatory discussions. Nevertheless, even if proclamations were made about the need for professional guidance, the recommendations frequently veered towards regulation of information provided to the consumers e.g. , suggestSimilar industry self-regulation has been observed by An important component of the nutrigenetic testing companies' marketing were descriptions of the advice or treatment offered based on the genetic test. The companies' profiles also differed in this respect.First, make your choices from a variety of whole foods each day, preferably organic whole foods. Click here to read What about whole foods? Whole foods retain all their original nutrients, in the correct proportions intended by Mother Nature .Sciona, in particular, focused on offering advice on diet and foods:In this statement, Sciona emphasized the “naturalness” (with references to organic foods and Mother Nature) of the treatments it offered. This description accomplished two things. First, it mobilized the ubiquitous marketing discourse for things “natural” that frequently evoke notions of wholesome past and non-Western cultures to sell varied products from perfume to fair-trade coffee beans .The doctor recommended 81 mg dose of Aspirin with the combination of Vitamins B6, B12, Folic Acid, L-Arginine and Aged Garlic ExtractHowever, the innocuousness of the advice also became a target of criticism. In the GAO report, nutrigenetic testing companies were accused of offering “common sense” advice, such as recommending eating vegetables, as allegedly genotype-specific . This crThese formulas constituted quasi-medicines – often containing vitamins, plant extracts and compounds possibly having health benefits – between food items and drugs. The way in which the formulas were described and concocted also strategically associated them with “natural” remedies, such as garlic and other plant compounds, and medicine, such as Aspirin.The knowledge of the personal genomic constellation of a patient helps the physician to select suitable primary preventive therapeutic measures as well as to plan individual medication in order to avoid or reduce specific risks of developing CVD [cardiovascular disease] .Still, a few nutrigenetic testing companies indicated on their webpages that they would provide advice about “medical” treatments:Here Genetic Health, referring to medications, indicated that its physicians would provide advice about pharmaceuticals in association with the genetic test. In so doing, the company represented itself as providing “proper” or serious and specific interventions, rather than general dietary advice or ambiguous quasi-medicines. At the same time, it also made the company liable to accusations of “unnecessarily” medicalising people in light of the questionable validity of the tests, which has been raised by genomic researchers  and reguThe regulatory initiatives focused on the nutrigenetic testing technology and treatments and advice were only referred to in terms of the potentially harmful “effects” of the tests : 2. TherThe little research published on nutrigenetic testing so far has focused on the poor quality of information on the companies' webpages e.g. , althougWe have not evaluated the webpages against a standard or reflected on how the information and products offered by nutrigenetic testing companies should be regulated. Rather, we have examined how these scholarly, regulatory and popular discussions were creating a new social space for products between medicine and consumer culture, which was unraveling on the companies' websites.The existence of markets for consumer goods with healing qualities is, obviously, not new see . What weSociologists have argued that contemporary medicine and science are losing their 20th century autonomy and become infused with commercial, government and lay interests. This has been described by terms such as biomedicalisation  or mode Social scientists have noticed the emergence of “lifestyle” products, such as commercial genetic tests and drugs e.g. . Yet, thWe have argued that the regulation of nutrigenetic tests was ambiguous part because the novel tests fell between the cracks of existing regulation. But the contradictory comments and recommendations made by genomics researchers and policy makers about the tests was also influenced by the fact that they shared the companies' interest in promoting genomic applications and the contemporary individualist self-health agenda. This illustrates how the new regulation was facilitated by the specific interests of genomics research and policy community and the broader individualist or neo-liberal zeitgeist, which forged the commercial, government and scientific agendas behind the new category.We have pinpointed how the companies mirrored and negotiated the regulatory positions by associating their services with health, medicine and science but framing them  as more In this new area, many questions remain. For example, whilst nutrigenetic expands biomedical jurisdiction into eating, it also operates in reverse, rendering a rarefied medical technology—genetic testing—consumer culture. Whilst (bio)medicalisation has been extensively studied, consumerization, i.e., rendering a medical technology consumer culture has rarely been investigated. It raises the question of, for example, whether and how does the meaning of genetic testing change for the consumer when it is sold adjacent to garden furniture online. How people understand and use lifestyle technologies clearly begs further research.Furthermore, in 2009 Sciona and its distributors ceased selling nutrigenetic tests. This could be due to the drying of investment funds amidst global economic downturn or competition from new companies, such as 23andMe and deCODEme, selling whole genome scans. It is unclear if nutrigenetic testing as a business concept will survive, even if commercial genetic testing seems here to stay. We have here argued that the emergent categories between medicine and consumer culture, so well illustrated by nutrigenetic tests, are a broad phenomena, not limited to genetic testing. How the lifestyle market develops and perhaps consolidates into some consistent regulatory and marketing frameworks also calls for more research.