10.6092/issn.2038-3460/17413
A core aspect of the entrepreneurial hospital is the mobilisation of the means of care beyond care itself. In previous work, we showed how the entrepreneurial hospital uses its unique access to patient populations, whose health needs make them available, in order to facilitate research into therapeutic, diagnostic, or service delivery innovation. It ‘entrepreneurialises’ care, we argued, to meet research needs. What may be less obvious in this process, however, is that research, too, is entrepreneurialised to meet care needs. That is, the entrepreneurial hospital not only constitutes its patient populations and care infrastructure as distinctive assets that serve its entrepreneurial aims, but also positions its entrepreneurial aims as a decisive element in the service of care. This article develops the concept of the entrepreneurial hospital to help theorise biobanking. It foregrounds the views of biobankers – drawing from our ethnographic research and especially our interviews with key-informants (2008-2009) who work in some relation to biobanking in a Canadian province – thereby providing a window onto an important, yet under-examined, set of rationales motivating the entrepreneurial integration of care and research through biobanks.
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Renata Axler
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Tecnoscienza – Italian Journal of Science & Technology Studies
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“It’s Actually Part of Clinical Care”. Mediating Biobanking Assets in the Entrepreneurial Hospital
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2019-01-31
2023-06-25
2019-01-31
2023-08-31
133-158
TS
Renata Axler
2018
10.6092/issn.2038-3460/17413
133
University of Toronto
2038-3460
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healthcare
en
158
“It’s Actually Part of Clinical Care”. Mediating Biobanking Assets in the Entrepreneurial Hospital
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9
                                                                                        Essay
“It’s Actually Part of Clinical Care”
Mediating Biobanking Assets in the Entrepreneurial
Hospital
     Martin French                        Fiona A. Miller            Renata Axler
       Concordia University                  University of Toronto   University of Toronto



   Abstract: A core aspect of the entrepreneurial hospital is the mobilisation
   of the means of care beyond care itself. In previous work, we showed how
   the entrepreneurial hospital uses its unique access to patient populations,
   whose health needs make them available, in order to facilitate research into
   therapeutic, diagnostic, or service delivery innovation. It ‘entrepreneurialis-
   es’ care, we argued, to meet research needs. What may be less obvious in
   this process, however, is that research, too, is entrepreneurialised to meet
   care needs. That is, the entrepreneurial hospital not only constitutes its pa-
   tient populations and care infrastructure as distinctive assets that serve its
   entrepreneurial aims, but also positions its entrepreneurial aims as a deci-
   sive element in the service of care. This article develops the concept of the
   entrepreneurial hospital to help theorise biobanking. It foregrounds the
   views of biobankers – drawing from our ethnographic research and espe-
   cially our interviews with key-informants (2008-2009) who work in some
   relation to biobanking in a Canadian province – thereby providing a window
   onto an important, yet under-examined, set of rationales motivating the en-
   trepreneurial integration of care and research through biobanks.

   Keywords: biobanks; public participation; biosociality; personalized health;
   genomic research: healthcare.

   Corresponding author: Martin French, Department of Sociology &
   Anthropology, Concordia University, 455 de Maisonneuve Blvd. WH-1125-
   44,     SGW     campus,     Montreal,     Quebec,    Canada     Email:
   martin.french@concordia.ca.




1. Introduction

    How should we think about biobanking in relation to the entrepre-
neurial hospital? In earlier work, we argued that – unlike the much-
discussed “entrepreneurial university” (see, among many: Bok 2003; Etz-
kowitz 1998; Owen-Smith 2005; Slaughter and Leslie 1997) – entrepre-

TECNOSCIENZA
Italian Journal of Science & Technology Studies
9(2) pp. 133-158 - ISSN 2038-3460                      2018
www.tecnoscienza.net
134                                                           Tecnoscienza - 9 (2)

neurial hospitals have been largely unnoticed, in spite of their significant,
distinguishing characteristics. For whatever reason, research theorizing
the rise of the “commercial ethos” (e.g. Etzkowitz 1983) in bioscience has
largely tended, until recently, to ignore the specificity of the hospital set-
ting. What is missed, in overlooking this setting, are the particular ways
that patient populations and care infrastructure are constituted as distinc-
tive assets in pursuit of entrepreneurial aims (French and Miller 2012).
From where we write, in Canada, our investigations into entrepreneurial
hospitals have illuminated some of the tensions underlying their efforts to
hybridize multiple logics of healthcare, with those of innovation, comer-
cialisation, technology transfer and economic growth. Insofar as they are
positioned to care not just for health, but also for wealth, entrepreneurial
hospitals reflect a considered attempt on the part of the health research
and care communities to “leverage a joint solution to parallel problems of
constrained public finances, growing need, and the limited success of
persistent, independent efforts at reform” (Miller and French 2016,
1541). Key focal points within this considered attempt, as we discovered
in the course of our empirical work, are biobanks. Insofar as biobanks
represent sites of accumulation (of tissue, data, expertise, and so on)
within the entrepreneurial hospital, they act as crucibles for both the in-
tensification and mitigation of the tensions mediated by this organization.
The goal of this article is to examine the relationship of the biobank to
the entrepreneurial hospital, with reference to sociology’s and science and
technology studies’ (STS) engagements with biobanking.
    A core aspect of the entrepreneurial hospital is the mobilisation of the
means of care beyond care itself. For example, the entrepreneurial hospi-
tal uses its unique access to patient populations, whose health needs make
them available, in order to facilitate tailored research into therapeutic,
diagnostic, or service delivery innovation. In this respect, the hospital-
based biobanks we examined are different from ‘national biobanks’ – an-
alysed by Busby and Martin (2006), Mitchell and Waldby (2010), and
Tutton (2002; 2007), among others – where there is a need ‘to drum up
volunteers’ independently of their access to medical care (Mitchell 2012,
231), and where many of the volunteers would be healthy. The biobanks
we studied typically receive tissue samples and patient histories from in-
dividuals who, as part of their care, have been asked to donate their mate-
rials and information. Patients, according to a website of one of the bi-
obanks we examined, “are offered the opportunity to participate [in re-
search] at the time of their first appointment”, when they are asked to
provide a blood sample and also for permission to be contacted for future
research projects. This biobank thus takes advantage of the entrepreneur-
ial hospital’s patient population and care infrastructure to meet its re-
search goals. We might therefore say that care is here ‘entrepreneurial-
ised’ to meet research needs – this is an example of the mobilisation of
the means of care beyond care itself.
French, Miller and Axler                                                    135
    What may be less obvious in this process, however, is the potential of
research to be ‘entrepreneurialised’ to meet care needs. Indeed, this arti-
cle will present data illustrating how biobankers working within the en-
trepreneurial hospital make sense of their efforts with respect to care. We
will also highlight discourse arguing that biobanks, in this context, do not
only aim to realise their research needs, but also position their research
and entrepreneurial aims as decisive elements in the service of care.
    Although it may be tempting to dismiss such positioning as a form of
rhetoric designed to mollify public sentiment in contexts where the “core
publicness” (Anderson 2012) of care is increasingly instrumentalised ac-
cording to non-public (e.g. professional, organizational, commercial, etc.)
interests, we identify in this article its potential to play an important me-
diating function. Indeed, it seems that the entrepreneurial hospital excels
at mediating between incommensurate value systems. This mediation
work, as we will show, is deftly performed in the biobanking context
(Tupasela and Snell 2012), illustrating how biobanks can operate as in-
termediaries that help maintain the entrepreneurial hospital’s social li-
cense and legitimacy (Dixon-Woods and Ashcroft 2008; Dixon-Woods
and Tarrant 2009). It may also help to explain why patients willingly par-
ticipate in research initiatives like biobanking when the direct benefits to
their health may not be apparent1.
    Moreover, by empirically advancing the concept of the entrepreneuri-
al hospital to help theorise biobanking, this article makes two contribu-
tions to the literature. First, it pulls the substantive-theoretic scholarly fo-
cus upon biobanks to a meso-organizational level, emphasising the lay-
ered, complex socio-technical networks in which biobanks are embed-
ded. Second, it shifts the empirical focus (dominant in the sociology of
biobanking) from the views of lay-participants to the views of biobanking
and health professionals, thereby providing a window onto an important,
yet under-examined set of rationales motivating the entrepreneurial inte-
gration of care and research through initiatives like biobanks.
    In what follows we first provide a brief discussion of the entrepre-
neurial hospital, focusing on its emergence and contemporary context.
We next discuss literature on biobanks with a focus on two strands of
work, 1) related to hybridization of public- and private-sector logics, and
2) related to the incommensurate (bio)values mediated by biobanks.
Then, following a discussion of method, we present data from our ethno-
graphic research, drawing primarily from twenty-six semi-structured in-
terviews with key-informants (2008-2009), who work in separate but net-
worked organizations at a number of physical sites, with responsibility for
the provision of care for a geographically defined population. Taken to-
gether, the network possesses a substantial research infrastructure, well
developed affiliations to the local, university-based medical school, as
well as connections to other universities. We discuss biobanking in the
context of this network, and the entrepreneurial hospital more generally.
We present two discursive orientations that emerged in our data, which,
136                                                            Tecnoscienza - 9 (2)

while complimentary, may also evince some tensions. We conclude with a
reflection on the implications of these tensions for the future of biobanks
– and the entrepreneurial hospital more generally – focusing in particular
on tensions between the imperative to grow the biobank’s network and
the imperative to maintain its social license.


2. Entrepreneurial Hospitals: The Emergence of a Novel
Organizational Form

    In Canada – the site of our empirical work – entrepreneurial hospitals
have emerged against the backdrop of a pervasive effort to re-imagine the
meaning and hidden potentialities of publicly-funded healthcare. At issue
is how to transform a long-standing commitment to public-funding for
care into a national competitive advantage in biomedical innovation. The
visualization of this transformation has become a matter of policy for
governments and other organizations involved in the funding and con-
duct of health research (e.g. ACAHO 2007; CIHR 2006 and 2009; Gov-
ernment of Canada 2007; Naylor et al. 2015; see also Atkinson-Grosjean
2006; Miller and French 2016).
    By no means unique to the Canadian context (e.g. BIGT, 2004; CFST,
2011), the aspirational policy discourse aimed at producing national
wealth by leveraging healthcare infrastructures and patient populations
reflects organization-level developments designed to mobilise care in
commercial ways. For example, a characteristic feature of entrepreneurial
hospitals in Canada is the articulation of mission-statements, policy, and
funding priorities meant to accelerate innovation, technology transfer and
commercialization. Consequently, a number of entrepreneurial hospitals
have developed in-house expertise in technology transfer and commer-
cialisation, offering their health researchers a range of services related, for
example, to intellectual property (IP) protection, material transfer, and
non-disclosure-agreements, patent searches and applications, business
development planning, and so on.
    Given this policy focus, it is apparent that the entrepreneurial hospital
is designed to do far more than merely provide care. At the same time,
because it is a hospital, care provision remains core to its mission, provid-
ing a basis for hybridizing multiple logics, including logics for health re-
search, health care, innovation, technology development and commercial-
ization. For its proponents, the entrepreneurial hospital’s cutting-edge
biomedical expertise, supported by data-sets on treatment regimes and
outcomes, growing tissue repositories, and large populations of patients,
make the organization into a catalyst of biotechnological innovation.
    To the extent that it embeds entrepreneurial aims into the traditional
organization of care, the entrepreneurial hospital must maintain the ca-
pacity to address a diversity of problems, and not just those directly relat-
ed to care. For this reason, it would seem that at least two types of re-
French, Miller and Axler                                                137
search are privileged by the entrepreneurial hospital: 1) research that is
seen to have direct clinical applicability; and 2) research that is seen to
have clinical applicability in future (French and Miller 2012; Miller and
French 2016). Biobanks – characterized by accumulative practices that
harvest patient tissue and information on a routine basis in the course of
care – derive utility in the context of the entrepreneurial hospital by
straddling and enabling both types of research. They may be used as plat-
forms that address well-defined research questions articulated in present
circumstances. Yet their value stems also from their potential to collect a
population’s past, lived experience with disease (registered in tissue and
information) in case it may serve future and as yet undefined research
needs.
    We turn now to a discussion of sociological and STS engagements
with biobanking. Then, following a brief discussion of method, we pre-
sent data that illustrate how the entrepreneurial hospital seeks to leverage
its biobanking potentiality.


3. Sociological and STS Engagements with Biobanking

    Sociological and STS accounts of biobanking have grown substantially
in the past decade (see, for example, Lipworth et al. 2011) and we cannot
be exhaustive in our review of the literature. Instead, we concentrate on
two strands of work related to 1) the hybridization and entanglement of
public and private-sector logics in biobanking, and 2) the incommensu-
rate (bio)values mediated by biobanks.

3.1 Hybridization and Entanglement

    Against the backdrop of earlier research that had discussed biobank
development according to two different and mutually exclusive logics
(those of the public sector and those of the private sector), a number of
sociological and STS accounts of biobanking have taken up the ‘hybrid’
nature of biobanks – more specifically, they have focused on the hybridi-
zation of public and private interests, on how they intersect, reinforce
each other, and work within complex social, political, ethical and eco-
nomic spheres. For example, Hauskeller and Beltrame, in their study of
umbilical cord blood banking, argue that there is no clear-cut division be-
tween public- and private-sector biobanks; rather, viewed as biotechno-
logical platforms (Keating and Cambrosio 2000), cord blood biobanks
exhibit “a growing hybridization between the public and the private
model” (Hauskeller and Beltrame 2016a, 416). As they note, the “net-
work of actors, objects and practices involved in biobanking creates
shared organizational interdependencies that foster the coexistence and
hybridization of both redistributive public and private market bioecono-
mies” (Hauskeller and Beltrame 2016a, 416).
138                                                           Tecnoscienza - 9 (2)

    Central to understanding how all kinds of hybridization flow from,
and contribute to, the network of public-private bioeconomies made up
by the global system of biobanks is the concept of “entanglement”. Cal-
lon (1998, 19) uses the concept of entanglement as a way of theorizing
“the process of ‘marketization’ and the relations that are either hidden or
surfaced in the performance of market transactions”. Hauskeller and Bel-
trame (2016a, 425) build on this by pointing, in the context of cord blood
biobanking, to the way that entanglement is formed through “coopera-
tion across the public and private sector”, as well as to how this coopera-
tion “produces configurations within the regimes of [cord blood]
biovalue exploitation that account and serve both institutional forms and
maintain them in their differences and hybridity”. In other words, the
concept of entanglement highlights for analysts the fact that there are re-
lations that – to use Callon’s term – “overflow” the boundary between
public and private. For Hauskeller and Beltrame (2016a, 429) the con-
cept of entanglement helps illustrate how even apparently public bi-
obanks operating on a redistributive model have developed in “symbio-
sis” with the market economy. Ostensibly public biobanks are, thus, also
governed by economic principles. However, “the search for profit is not
the central engine of this market”; instead, the “economic principle that is
dominant in public banking is one of self-preservation and sustainability”
(Hauskeller and Beltrame 2016a, 429).
    Given this situation of entanglement, it is important to locate and
study what Hauskeller and Beltrame (2016b) elsewhere describe as “hy-
brid practices” in biobanking. Hybrid practices play across, and reshape,
the boundary between public and private biobanking practices. They blur
the borderlines between research, clinical care, commercialization, volun-
teerism and citizenship within the biobank. They may, for example, in-
voke ideals of nationhood and supposed genetic homogeneity that reach
back to time immemorial while also mobilizing a “diverse and multicul-
tural national identity” to ensure the participation of “ethnic minority
groups” (Busby and Martin 2006, 245-246; see also Busby 2004). They
may encourage patients to see their participation as combining “their per-
sonal health project with a sense of contributing to efforts undertaken by
the welfare state” (Hoeyer 2003, 235). They may seek to manage –
through rhetorics of standardisation and governance, as well as through
public engagement exercises – the uncertainties of public opinions about
the “substantial commercial interests” (Tutton 2004, 20; see also
Tupasela et al. 2015) that direct public funding of biomedical research
and the development of biobanking platforms. They may blend narratives
of health with those of wealth, emphasizing how biobanking can benefit
wider national economies (Lewis 2004; Cooper and Waldby 2014). Hy-
brid practices, in other words, emerge in relation to the structural realities
of biobanks that straddle public- and private-sector boundaries; they
work not just to navigate these boundaries, but also to actively constitute
them.
French, Miller and Axler                                                139
    In this sense, we might think of the hybrid practices developed by bi-
obanks expressions of the “tension between ethical, scientific and com-
mercial values” (Timmons and Vezyridis 2017, 1). For example, Timmons
and Vezyridis (2017, 11), in their study of what we would characterize as
an entrepreneurial hospital in the UK, observe how the biobank “bro-
ker[s] the commodification of its own assets between academia and the
market”, acting as “both a producer and seller of biospecimens”. Similar-
ly, Turner and colleagues (2013, 70) find that biobanks are “caught di-
rectly between the values and rights of the participants and the potential
commercial and scientific value of the samples and data”, while at the
same time “construct[ing] a business model that will ensure the long-term
sustainability of the biobank”. These tensions give rise to, but are also
managed by, hybrid practices. Indeed, it is worth stressing here that ten-
sions are not necessarily impediments to development. Bunton and Jones
(2010) demonstrate, for instance, how biobank stakeholders envision
commercial as well as global scientific and public health value in biobank-
ing efforts. Biobanks may thus deploy hybrid practices to negotiate with –
and even leverage – the tensions that accompany public- and private-
sector boundary “overflow”.
    Taking these observations together, it is clear that contemporary
scholarship on biobanks must examine efforts to mediate between com-
mercial and healthcare logics (Miller and French 2016), as well as the en-
tanglement of (hybrid) practices that these efforts entail. Moreover, in our
view, it is important to turn scholarly attention to the precise ways that
the intermediary role of biobanks is configured and enacted. As we shall
suggest, in the biobanks that we studied – with their specific relation to
the mission of the entrepreneurial hospital – the configuration of mediat-
ing hybrid practices seemed to be optimized to walk the razor’s edge be-
tween achieving economic growth and maintaining social license. A key
question, therefore, is whether and how particular types of organisations
and expertise are called into being by the effort to successfully balance
amongst all of the various biobank’s entangled commitments.

3.2 The Incommensurate (bio)Values Mediated by Biobanks

    A number of concepts are available to help theorize these mediation
efforts and their entangled hybrid practices in biobanking and in the con-
temporary biosciences more generally. Some have turned to the concept
of commodification (e.g. Sharp 2000; Rose 2001); others have advanced
the idea of biocapital (Sunder Rajan 2006); and others have been critical
of these developments (e.g. Helmreich 2008; Birch and Tyfield 2012). As
we developed our work on the entrepreneurial hospital, we found
Waldby’s (2000; 2002) conceptualization of biovalue to be particularly
useful, especially as elaborated with Mitchell in their book, Tissue Econ-
omies (Waldby and Mitchell 2006), and in subsequent work (e.g. Mitchell
and Waldby 2010).
140                                                            Tecnoscienza - 9 (2)

    Waldby, drawing from a range of theorists (and not just Marx, as
some critics have seemed to suggest), provides the foundational articula-
tion of biovalue in her book on The Visible Human Project, where she
defines it as “a surplus value of vitality and instrumental knowledge”
(Waldby 2000, 19) derived from nature’s participation in technology, and
the configuration of this participation so as to solicit compliance from the
productive capacities of living matter. Biovalue, in other words, is the
“the yield of vitality produced by the biotechnical reformulation of living
processes” (Waldby 2002, 310).
    Waldby and Mitchell (2006, 108) elaborate on this idea in the context
of their work on biobanks, arguing that biovalue “refers not to the stable
and known properties of tissues but to the capacity of tissues [under the
conditions of the types of socio-technical configurations made possible by
biobanks] to lead to new and unexpected forms of value”.
    In the context of their work on national biobanks, Mitchell and
Waldby (2010) further specify their conceptualization, noting two differ-
ent modalities of biovalue, one that depends on the separation of individ-
uals from their biological materials, and one that requires the mainte-
nance of linkages between them. These modalities, while different, oper-
ate together and we certainly see both modalities in the biobanks we stud-
ied, expressed, as we shall argue, in the way that tissue is both separated
from and reconnected to patients and patient groups. Indeed, as we shall
indicate, we can understand the mediation work done by biobanks, and
by the entrepreneurial hospital more generally, as mediating between the-
se modalities of biovalue.
    In making this observation, we are also sensitive to Birch’s critique of
the concept of biovalue (and the other ‘bio’ concepts), which, he argues,
tend to allow analysts to over-emphasize the bio aspects of the bioecono-
my at the expense of understanding its political economic aspects. While
we do not entirely follow Birch (2017) in his critique of the bio-concepts
because, in our view, it is perhaps too dismissive of their analytic utility,
we have nonetheless found his account of assetization useful for thinking
about the nature of the incommensurate (bio)values mediated by the en-
trepreneurial hospital.
    Birch’s conceptualisation of assetization is grounded in a broader dis-
cussion of financialization and capitalization, which, owing to space con-
straints, we cannot fully cover here. For our purposes the key points of
Birch’s analysis can be summarised as follows:
  1. For firms in the life sciences sector, profits are just as – if not more –
      likely to come from “licensing, partnerships, royalties, and so on
      (i.e., asset-based income)” as they are to come from “product sales
      (i.e., commodity-based income)” (Birch 2017, 465).
  2. Asset-based income for firms in the life sciences sector is rooted in a
      range of valuation practices that can, when taken together, be
      thought of as the discounted present value of a future stream of
      earnings (Birch 2017, 466).
French, Miller and Axler                                                  141
  3. “the configuration of value through these diverse valuation practices
      involves the transformation of something into a recurring source of
      revenue – that is, turning something into an ‘asset’ – rather than its
      transformation into a commodity” (Birch 2017, 468).
    Birch conceptualises assetization “as a process in which value is con-
stituted by the management of value and valuation, especially as they re-
late to organizational entities and their capacities” (Birch 2017, 470). It
reflects “a dual process” involving the transformation of knowledge into
IP, “and the monetization of that knowledge asset as a source of value
(e.g., out-licensing IP)” (Birch 2017, 474).
    For our analysis of the way that the entrepreneurial hospital mediates
amongst incommensurate biovalues, it will be important to think about
what it means for biobanks to produce economic value not from com-
modities per se – not from bringing scientific knowledge from bench to
bedside – but from assets. This may have, as we shall suggest, important
implications for the maintenance of the social licence of the biobank and
the entrepreneurial hospital more generally, especially if it comes to be
perceived in terms of “non-reciprocation” (Carter et al. 2015). Beyond
this, and riffing on Birch’s argument for the analytic decomposition of the
concept of bioeconomy into its constituent ‘bio’ and ‘economic’ parts in
order to better specify its bio-technological and political-economic com-
ponents, we want to suggest that the concept of biobank might admit a
similar analytic decomposition into its biological (bio) and institutional
(bank) components; however, it is precisely because of the mediation
work done by the entrepreneurial hospital that the biobanks we studied
avoid such decomposition.


4. Method

    The data presented below are part of a larger study designed to exam-
ine biotechnological innovation in entrepreneurial hospitals in Canada
(French and Miller 2012; Miller and French 2016). Following ethics re-
view and clearance from the University of Toronto, we undertook (be-
tween 2008-2009), ethnographic fieldwork including extensive review of
organizational documents, field-site visits, and twenty-six semi-
structured, key-informant interviews with participants working in net-
worked organizations within a single Canadian province, in a health sys-
tem that provides publicly-funded, universal access to physician and hos-
pital care. In this article, our analysis concentrates primarily on our inter-
view data.
    Initially our purposive sampling strategy targeted potential study par-
ticipants working at the “bench-bedside interface” (Wainwright et al.
2009, 960). We interviewed senior hospital administrators, clinicians and
researchers, as well as professionals working in the hospital’s technology
transfer office (n=15). Then, to better understand issues specific to the
142                                                         Tecnoscienza - 9 (2)

commercialisation of innovations derived from research with patient bi-
omaterial and information, we focused on finding informants involved in
biobanking. We interviewed administrators, researchers, clinical staff and
information technology specialists working with biobanks housed in, or
affiliated with, the entrepreneurial hospitals we studied (n=11). Averaging
about 1 hour in length, interviews were conducted in person (n=13) and
by telephone (n=13) and were audio recorded and transcribed verbatim.
    Our analytic approach was informed by constructivist grounded theo-
ry and methods (e.g. Bryant and Charmaz 2007), and especially situation-
al analysis (Clarke 2005). Working collaboratively, we analysed our inter-
view data for emergent themes.


5. Results

    Our participants are involved, to varying degrees, with different di-
mensions of biobanking – they may get tissue from biobanks to facilitate
their research (researchers), procure patient material and data (clinicians
– nurses and doctors), secure patient consent for participation (research
assistants), negotiate partnerships with external parties (technology trans-
fer professionals), directly oversee the day-to-day operations of a biobank
(administrators), or create strategies that align biobanking activities with
broader organizational missions (senior administrators). All position bi-
obanking as an integral research undertaking within their healthcare or-
ganization. Accordingly, while having diverse views on what biobanking
is, and what it ought to accomplish, all see biobanking as an enterprise
with the potential to contribute to the overall healthcare mission of their
hospitals.
    Below we have broadly categorized our data according to two over-
arching discursive orientations. On the one hand, we see a discourse that
emphasizes the fundamental materiality – tissue – at the heart of bi-
obanks. It describes biobanks as tissue repositories, access brokers, and
as holding the currency of translational research. This orientation may be
said to reflect the “bio”-ness of biobanks, (problematically) evoking no-
tions of tangible goods that possess an inherent value, which, under the
right conditions, may be extracted and leveraged. On the other hand, we
see a discourse that emphasizes patients, which locates the biobank with-
in the broader context of the entrepreneurial hospital. It describes bi-
obanks as entangled with universally accessible healthcare systems, as well
as with the work of clinical care. This orientation may be said to reflect
the “bank”-ness of biobanks, (problematically) evoking notions of the in-
stitutionally-housed intangible dimensions of tissue collections that see
them as deriving value through their relation to data about patients,
treatment outcomes, and the broader, institution-level logics of care that
characterize hospitals2. These orientations are not mutually exclusive. In-
deed, we argue that they are made to work together by the entrepreneuri-
French, Miller and Axler                                                     143
al hospital, and therefore, when read in conjunction with all of their ten-
sions, they exemplify the crucial mediation work performed by the entre-
preneurial hospital.

5.1 Tissue

   There are differing accounts in the literature over what, exactly, are
the important, defining characteristics of a biobank (e.g. OECD 2006).
On the surface, the necessary (if not sufficient) condition for constituting
a biobank would seem to be the possession and/or accumulation of (hu-
man) biological tissue. However, as we shall suggest, this focus on tissue
presents a rather minimalist representation of what makes up a biobank,
and of what biobanks can do.

Biobanks as tissue repository

    To be certain, human tissue is regarded as fundamental to biobanking
in the context of the entrepreneurial hospital, which emphasizes the im-
portance of translational research. Indeed, so central has been the posses-
sion of human tissue to the development of biobanking in this context,
that one veteran of the field – a biobank director we interviewed – ex-
pressed the following axiom in his concluding remarks to us: “he who has
the tissue rules” (BIA-39).
    Conveying a sense of exasperation with the slow development of bi-
obanking research in Canada, especially with respect to biomarker dis-
covery and validation, our study participant prefaced his axiomatic state-
ment about the centrality of human tissue by asking:

    How are you going to find frickn’ solutions for things? In vapour ware?
    […] the reality is in the final analysis, you have to try it out in humans
    […], with human urine, blood, joint fluid, biopsy tissue… (BIA-39)

   Biobanks, in this sense, are fundamentally repositories of human tis-
sue that enable the discovery of healthcare solutions. As a biobank ad-
ministrator notes:

    Being able to make that jump from a cell line or an animal model into a
    human tissue model really advances the science, but you need those spec-
    imens to be able to do that research. (BIA-42)

    These observations underscore the importance of the human bio-
material resource at the heart of biobanking. This resource is rooted in
access to patients and patient populations, well-developed, computerised
medical records systems, and a range of other affordances that attend
hospital care, thus making the apparatus that brokers ethical access to pa-
tients essential.
144                                                                 Tecnoscienza - 9 (2)


Biobanks as access brokers

   Describing a situation in which access is brokered, one of our partici-
pants notes that “a lot of the work I do” is with:

      commercial entities, often with very good ideas […] for some sort of nov-
      elty test […]; in theory it works well, but what they do not have access to
      is our, let’s say, large pool of anonymized patient specimens. (BIA-36)

    In the absence of trying their theories out using the hospital’s “speci-
mens”, the commercial entities in this example “cannot actually go ahead
and develop their tests” (BIA-36). Our participant, who was a laboratory
researcher, was – following a process of ethics review and “ethics paper-
work” (BIA-36) – able to access anonymized human tissue samples stored
in a hospital biobank. For diverse users, including those working in the
private sector, access to tissue is both made possible, and legitimated, via
an oversight and governance process, brokered by the entrepreneurial
hospital.
    The biobanks we studied were described as resources that could sup-
port translational research at the local, national and international level.
This orientation towards translational research sometimes means forming
partnerships with private sector organizations because, in the words of
one participant, “we [the entrepreneurial hospital] don’t have the re-
sources here to actually take something to market” (BIA-28). From this
perspective, the biobank plays an important brokering role, adjudicating
proposals for research with the interests of its patient population in mind,
while also perhaps bringing a solidaristic sense of legitimacy to research
undertaken by its private sector partners. We see, here, not only the hy-
brid practices associated with adjudicating proposals, but also the institu-
tionalized capacity to govern adjudication according to standardized, in-
ternational norms. Indeed, as one biobank manager noted, “we are able
to facilitate the access to bio-specimens, which are needed for translation-
al research”: “the way our infrastructure is set up, it opens up channels
for researchers to have access to it [patient tissue]” (BIA-42).
    This point was underscored in our interviews with researchers who do
not themselves maintain biobanks, but who rely on their biobanking col-
leagues to broker their access to (human) biological tissue. As one re-
searcher noted, “we have technologies, genomic technologies, that can
interrogate genetic material but only if we can obtain samples” (BIA-28).
Access to patient samples is, in this case, seen to be a necessary condition
of advancing the research and collaboration that takes place within the
entrepreneurial hospital. Another researcher we interviewed also empha-
sized the importance of tissue access for the kind of research privileged
by the entrepreneurial hospital. Engaged in a technology development
project aiming to construct and validate a diagnostic device, this study
French, Miller and Axler                                                      145
participant stressed the importance of developing “the referral pathway”,
and of being able to access archived tissue, as well as a prospective stream
of samples (BIA-49). Without this access to patient tissue, it would not
have been possible to identify the molecular biomarkers used by this
technology.
    These observations link up with descriptions of biobanks as institu-
tions that broker and legitimate access to patient tissue. As Waldby and
Mitchell argue, biobanks play a central regulatory function in “tissue
economies”: they accumulate tissue from donor populations and medical
intermediaries; they process this tissue according to established technical
and ethical guidelines, as well as legislation; and they redistribute it in le-
gitimate ways that aim to maximize its utility (Waldby and Mitchell 2006,
35). Accordingly, while tissue accumulation is an essential feature of bi-
obanking, so too is the brokering of legitimate access to tissue. This in-
volves doing ‘public engagement’ and working on “public perception of
what it means to be a biobank” (BIA-42). In doing this work, in broker-
ing and legitimating access, the biobank becomes much more than a mere
tissue repository. By governing social relations amongst researchers and
publics, the biobank enacts a key, regulatory function of the entrepre-
neurial hospital, namely, the mediation of (new) uses of the patient popu-
lation.

Biobanks as the currency of translational research

   Several of our participants underscored how fundamental biobanks
were to health research, especially translational research. One of the bi-
obank directors we interviewed stated:

    Biobanks are crucial. Dry data and wet data are the currency – I don’t like
    using the word currency – but they are the currency of innovation with re-
    spect to translational research and understanding human biology […]
    translational research, for whatever purpose, for whatever question, re-
    quires exquisite, exquisitely phenotyped patients and exquisitely pheno-
    typed and quality assured biobanks. (BIA-39)

    As this study participant explained, the translational research con-
ducted by his organization would not be possible, would “not be even
imaginable, without quality assured, quality controlled, agile biobanks”
(BIA-39).
    Another participant, a clinician-researcher, draws a similar connection
between biobanking and translational research. In response to our open-
ing question designed to elicit information about our informants’ rela-
tionship to, and interest in, biobanking, this participant described “a de-
sire to create a significant research program”. He stated: “we realized
that, to have a research program that we envisioned, which was transla-
tional, it had to be biobanking” (BIA-46).
146                                                                  Tecnoscienza - 9 (2)


5.2 Patients

    To this point, the characterization of biobanking is highly tangible, in
its sources, practices and impacts. Below we present a more expansive
conceptualization of biobanking, characterized by a care-focused orienta-
tion that is not well recognized in the literature. It is given a particular va-
lence by the embedding of biobanks within the entrepreneurial hospital.
It explicitly entangles biobanking with care, thereby emphasizing the
networked nature of the biobank and—in tension with the emphasis de-
scribed in the previous section—de-centering the idea that biobanks are
all about tissue.

Biobanks as entangled with population-level, patient group treatment
outcomes

    Although possession and accumulation of tissue may be a defining
characteristic of biobanks, many of our informants were careful to specify
that, without the capacity to understand tissue in relation to patient rec-
ords, personal health histories, collective geo-demographic information,
risk exposures, treatment regimes, future patients, and the like, the bi-
obanking enterprise would add limited value to health research.
    To see how biobanks transcend their attachment to purely corporeal
artifacts by producing ‘bioinformation’ (Parry and Greenhough 2018),
consider how our study participants situate tissue in relation to infor-
mation gleaned during the course of clinical care. With reference to mak-
ing genomic discoveries, for example about the ways that complex thera-
peutic interventions interact with the genetic pre-dispositions of individ-
uals and groups, one study participant succinctly stated: “omic [genomic,
proteomic, etc.] knowledge is based on care of patients” (BIA-31). To
contextualize this statement, our participant described his research in the
following terms:

      I work […] to discover new omic information. And, the nature of [this]
      work is based on, the study of patient material. […] So, we will look at
      populations of patients, not just one, but a whole population of patients
      with a similar type of [disease]. We will take an omic discovery and we
      will correlate that with the clinical features of the patient group when they
      first present with their disease and then follow information on how they
      respond to therapies over time. And, so we very closely correlate an omic
      piece of information with a diagnostic or outcome result, and that out-
      come result is really what makes the omic piece important. (BIA31)

    In this description, research using patient materials is made valuable
through its linkage to, its correlation with, clinical information.
    This correlative capacity of biobanks to connect up with information
gleaned during the course of care was similarly underscored by another
French, Miller and Axler                                                      147
participant we interviewed, a clinician researcher who linked tissue sam-
ples with patient outcomes data:

    I set up a lab […], which uses tissue samples from [the hospital] and links
    them to outcome data […]. And, the [tissue] archives wouldn’t have been
    valuable without the [outcome] data. But, by putting them together we’re
    able to make something really good happen. (BIA-29)

    By situating biobanking initiatives within a broader organizational set-
ting characterized by relations of care – a unique feature, we believe, of
the biobanks we studied – our participants’ discourse illustrates that the
materiality of tissue is profoundly entangled within the broader networks
of the entrepreneurial hospital. We suggest, moreover, that the entangle-
ment of biobanking materials and practices with materials and practices
mobilised for care is a key function of the entrepreneurial hospital.

Biobanks as part of clinical care

    Biobanks have been described as serving therapeutic, forensic, diag-
nostic, and research-related ends. In spite of their potentiality to serve
these diverse ends, a great deal of focus in social scientific literature has
been concentrated upon future-oriented, research-related ends (Hoeyer
2008, 430). Somewhat missed in this focus is the potentiality of biobanks
to serve clinical ends in the present.
    As our participants describe, this clinical utility of biobanking stems
not solely from its promise of future improvements in care, of better,
more tailored treatments, but also from the symbolic capital it provides to
health professionals in the here and now of bedside interactions. Tapping
into the embodied, emotional and affective dimensions of patienthood
(cf. Kerr and Cunningham-Burley 2015), this way of thinking about and
articulating the role that biobanks can play in care typifies how the entre-
preneurial hospital not only constitutes its patient populations and care
infrastructure as distinctive assets in service of entrepreneurial aims, but
also positions its entrepreneurial aims as a decisive element in the service
of care. It presents a benefit that off-sets risks associated with biobanking
(e.g. risks related to discrimination, or breach of privacy). Although this
way of articulating the value of biobanks could be understood as a form
of self-justifying rhetoric, it also depicts an attempted virtuous cycle in
which care feeds into research and research feeds into care, all the while
functioning in a way that aims to be respectful of patient interests. This
notion of a virtuous cycle, resulting from pursuing both care and re-
search, seems to be fundamental to the raison-d’être of the entrepreneuri-
al hospital.
    One of our participants, a biobank director, made a sustained argu-
ment that biobanking is “actually part of clinical care” (BIA-43). His
analysis is nuanced and bears quoting at length:
148                                                                      Tecnoscienza - 9 (2)


      […] the other facet of biobanking, which is not just satisfying, but I think
      it’s very important, is that donors want us to ask them to provide their tis-
      sues and data. They say it loudly and resoundingly […]. When you ask
      somebody when they’re sick with a disease, do you want to donate to a bi-
      obank, it’s actually part of clinical care. When people come into a centre
      and they’re facing a problem, they want… Forty-nine percent of what they
      want is advice, management, treatment, to be cured or to resolve the pain,
      or whatever it is that is their problem. And, fifty-one percent of what they
      want, I believe, is they want us to provide them an opportunity to do
      something about it so that they don’t get a recurrence or their daughter
      doesn’t get the same disease or their neighbours and their friends. So, in
      that sense, when you treat a patient or provide advice, I think it’s incum-
      bent on us in healthcare to offer that opportunity at the same time as giv-
      ing our advice and our drugs and our treatment. And, so, in that sense,
      that fifty-one percent of the reason is, of why we should offer biobanking,
      is offering opportunity for patients to do something – they make a deci-
      sion. Their decision might be no, I don’t want to, but that’s therapeutic. A
      patient’s been given a chance to make a decision about their condition and
      their disease and their interaction with their healthcare. (BIA-43)

    In this passage of the transcript our study participant mobilizes a line
of argument that could be emblematic of the entrepreneurial hospital. As
with the entrepreneurial hospital’s investments in technology transfer, in-
novation, and commercialization initiatives (French and Miller 2012; Mil-
ler and French 2016), biobanking is here also constituted as part of a
broader, moral obligation owed to citizens, which stems from their sup-
port of publicly-funded healthcare.
    Although its mission involves constituting its patients and patient
populations as distinctive assets in the service of entrepreneurial aims,
these entrepreneurial aims are themselves enrolled, in a broad sense, in
the service of universal care. Our informant continues:

      [...] one additional point is that many patients are offered the opportunity
      to be involved in research and knowledge development that deals with
      their disease [...], but most of what is offered comes with entrance criteria
      and guidelines, which relate to the specific research question being asked.
      So, this is one of the benefits and the advantages of biobanking – you ask a
      patient a much more generic and fundamental question around involve-
      ment in research. You know, would you like your tissue and your blood
      sample and your health data to be collected, organized and then made
      available for research in the future and we’re not sure what that research
      project is, but we’ll set up the appropriate mechanisms to make sure that,
      if it’s used, it’s used appropriately, ethically, and for good science. And,
      that’s essentially the biobanking transaction. But, when we offer that to
      patients, we can offer it to all patients. [...] And, so, essentially, it’s a very
      equitable and open opportunity to be involved in research that biobanking
      offers, which is distinct from most other kinds of research like a clinical
      trial which is very specific. You’ve got to have this disease. You’ve got to
French, Miller and Axler                                                         149
    be going to a centre where the clinical trial is open and you have to meet
    all these criteria. And, if you don’t meet those criteria, we can’t offer this
    to you; whereas we can offer biobanking to everybody. (BIA-43)

    As noted, our research was conducted in a health system that provides
publicly-funded, universal access to care. In the above passage, participa-
tion in research biobanks is also framed as a matter of access (as opposed
to, or perhaps in addition to, a matter of obligation). As our participant
asserts:

    …I think it’s incumbent on us to offer biobanking for free, and biobank-
    ing in the broad sense, meaning that we offer a patient an opportunity for
    their tissue and their data to be used for health research that generates
    new knowledge. (BIA-43)

    These points, of course, bear some critical reflection. As scholars
studying national biobanks have argued, patients may not experience the
offer to “do something” by participating in biobanking research as em-
powering (e.g. Tutton 2002; Busby and Martin 2006). Nevertheless, what
we wish to underscore by highlighting the above passages is that bi-
obankers actively work to make sense of their efforts with respect to care,
and this is indicative of the entrepreneurial hospital’s reconfiguration not
only of care so that it is addressed to research aims, but also of research
so that it is addressed to care aims.


6. Discussion

    In some senses, the discursive orientations that we have identified are
complementary discourses: they each speak to overarching aims of the
entrepreneurial hospital. Yet, in other ways, they exist in tension, one
emphasizing tissue as the key locus of biobank activity, the other fore-
grounding the patients, populations, information systems, and so on that
entangle biobanking practices with clinical care. To theorize these orien-
tations, let us circle back to the two strands of work we highlighted in our
literature review: 1) hybridization of public- and private-sector logics, and
2) mediation of incommensurate (bio)values by biobanks.

Hybridization of public and private-sector logics

    Dixon-Woods and colleagues (2008) argue that conceptualizing bi-
obanks and their publics as interdependent, mutually constitutive multi-
plicities is useful for understanding the existence of competing views of
tissue use. Drawing from Star and Griesemer (1989), they describe tissue
as a boundary object, an object that lets people cooperate without neces-
sarily having to agree upon how the object is defined, classified or valued.
150                                                                Tecnoscienza - 9 (2)

By emphasizing multiplicity in conceptualizations of biobanking – in un-
derstandings of public views and professional motivations – the authors
trouble analyses that characterize biobanks as drivers of body commodifi-
cation. They are critical of analyses that depict biobanks as:

      a particular, though pervasive and especially disturbing, case of a more
      general inclination on the part of biomedicine, bioscience and bioindustry
      to defile the sanctity of the body and the dignity of individuals. (Dixon-
      Woods et al. 2008, 58)

    For Dixon-Woods and colleagues, the problem with such accounts of
biobanking is that they assume 1) that participants can be easily duped
into colluding with their own objectification, and 2) that “tissue samples,
once they have crossed the boundary into the social world of the ‘re-
searcher’ inevitably become part of a commodified tissue economy”
(Dixon-Woods et al. 2008, 75). Having made this critique, the authors
argue that there is nonetheless a need to understand how biobanks oper-
ate in institutional contexts that might encourage individual researchers
to pursue commercial objectives. Regulating such pressures, they con-
tend, are powerful incentives, which can be regarded as a form of social
or reputational capital. In order to maintain this capital, biobanks must
operate, they argue, in ways that “sustain their social licence”, that are
seen “to act in the interests of donors”, and that do not risk the coopera-
tion of donors nor that of “the hospital staff who spend time and effort to
seek [patient] consent” (Dixon-Woods et al. 2008, 76).
    Drawing from Dixon-Woods (2008) and colleagues, one way to inter-
pret the statements of our study participants is as an effort to manage, in
an entrepreneurial way, the social capital of their initiatives. This involves
acting in ways that protect, but also grow, the investment made by bi-
obanking participants. We see elements of the effort to grow, while sus-
taining social license, in both of the discursive orientations we described.
Yet, the harmonious hybridization that this entanglement seems to have
accomplished might be undone if disagreements over fundamental char-
acteristics (definitions, valuations, etc.) are surfaced. And, in an almost
counter-intuitive sense, this is precisely what the patient-emphasizing dis-
course might do if the entrepreneurial hospital’s biovalue yields are ex-
pressed in assets (Birch, 2017) rather than, say, commodities.

Mediation of incommensurate (bio)values by biobanks

    We can see this unsettling potential if we look at the apparently har-
monious hybridization of the growth- and social license-imperatives
through the prism of biovalue. As noted, the concept of biovalue de-
scribes “the yield of vitality” that is gained “by the biotechnical reformu-
lation of living processes” (Waldby 2002, 310). It foregrounds the trade-
offs and (unintended) consequences that stem from different modalities
French, Miller and Axler                                                            151
of biovalue, for example those that depend on the separation of individu-
als from their biological materials, and those that require their linkage.
The entrepreneurial hospital, as we have argued, is well positioned to
mediate amongst these incommensurate values.
     Yet let us hypothetically push this mediation work beyond a threshold
and ask what would happen if the biobanking initiatives we have studied
do not lead to the hoped-for production of new diagnostic and treatment
technologies for future patients? Assume here that, when patients are of-
fered the opportunity to “do something” by participating in biobanking,
this something means contributing their tissue and information for trans-
lational research, which aims to help future patients through the creation
of new, life-saving diagnostic and therapeutic technologies. This some-
thing, in other words, is the creation of value ultimately through the pro-
duction of commodities (i.e. diagnostic and therapeutic interventions that
can ultimately be bought by the entrepreneurial hospital and deployed in
the clinic). However, the concept of assetization highlights the fact that
value in the life sciences sector frequently comes less from commodity
production than from financialized transactions involving the exchange of
assets (Birch 2017). For example, Lazonick and Tulum (2011), drawing
on the work of Gary Pisano (2006), argue that in the US biopharmaceuti-
cal sector, which is heavily subsidized by public funds, there is something
like a perverse incentive to try to monetize assets instead of pushing scien-
tific discoveries to market as commodities:

    …the highly financialized US business model in the BP [biopharmaceuti-
    cal] industry tends to undermine innovation by placing strategic control in
    hands of those who, primarily through stock-based compensation, have an
    incentive to make allocative decisions that, through speculation and ma-
    nipulation, increase their firm’s stock price even when such decisions im-
    pede the organizational learning processes that can result in a commercial
    drug. (Lazonick and Tulum 2011, 1185)

    In other words, those who stand to make millions from stock options
have an interest in raising stock prices, even if the tactics used to achieve
this end ultimately impede drug development. If we see this as a more
general trend that will frustrate the efforts of biobanks and translational
research to produce new, life-saving technologies, how long will the en-
trepreneurial hospital be able to maintain its social license? Birch provoc-
atively suggests that innovation strategies in the life sciences could be
conceptualized as a kind of reverse Ponzi scheme (cf. Mirowski 2012):

    it is the final private financier (e.g. late stage venture capitalist) who either
    accrues the highest returns or nothing at all from their investment, while
    the first financiers (e.g., friends, family, government, etc.) accrue the least.
    (Birch 2017, 465 – our emphasis)
152                                                             Tecnoscienza - 9 (2)

   From this perspective, the key question is, when will the bubble
burst?


7. Conclusion

    Our aim in this article was to examine the relationship of the biobank
to the entrepreneurial hospital. Drawing from sociological and STS ac-
counts of 1) the hybridization of public- and private-sector logics in bi-
obanking, and 2) the ways that biobanks mediate incommensurate
(bio)values, we suggested that biobanks act as crucibles for both the in-
tensification and mitigation of the tensions mediated by the entrepreneur-
ial hospital. We emphasized a meso-level analytic approach, using our
study participants’ discourses to reflect on organizational and network
dynamics. This approach underscored how the entrepreneurial hospital
works as an intermediary to confer legitimacy on its research and care
aims. Indeed, our analysis suggests that the entrepreneurial hospital is not
only entrepreneurialising care to meet research needs, but also trying to
entrepreneurialise research so that it meets care needs.
    In rendering this mediation work visible, we have also raised ques-
tions about its viability over the long-term, particularly as it relates to the
wider set of valuation and value-creation practices evident in the life sci-
ences sector, which have tended to favour the creation of assets rather
than commodities per se. Here, the key questions are: will the public and
biobank participants ever realize the promised returns of biobanking re-
search, and if not, (how) will the entrepreneurial hospital continue?
    In raising these questions we are suggesting the need for further re-
search. We are here mindful of the limitations of our study, namely that
we did not focus on the views of biobanking participants, that we did not
attend in extended depth to everyday biobanking practices as a longer
ethnographic study might, and that we focused on biobanking and the
entrepreneurial hospital in one province in Canada. These limitations
mean that we have been unable to explore participants’ views of the op-
portunity to “do something” via biobanking. We have not been able to
explore how variation in everyday practice might complicate the discur-
sive orientations we identified. And we have not been able to explore
how “generalizable” these phenomena are beyond our empirical setting.
These points, we suggest, represent fruitful avenues for future research.


Acknowledgements

    We are indebted to the many busy people who agreed to speak with us about
their work, and thank the Canadian Institutes of Health Research (CIHR) for
funding for this project (81195). While conducting this research, Fiona A. Miller
was supported by a New Investigator Award from the Institute of Health Services
French, Miller and Axler                                                     153
and Policy Research of CIHR (80495), and Martin French was supported by a
Fellowship from the CIHR-funded ‘Health Care, Technology and Place’ Strategic
Training Program and a postdoctoral fellowship from the Social Sciences and
Humanities Research Council (SSHRC) (756-2010-0741). While writing this
manuscript, Martin French had support via a SSHRC Insight Development Grant
(430-2016-00996) and an Action-Concertée grant from Quebec’s Fonds de Re-
cherche—Société et Culture (2017-BJ-202106). Sponsors’ support of this work
should not imply endorsement of the conclusions, for which the authors retain
sole responsibility. Martin and Fiona would like to thank Renata Axler, whose
amazing authorial help was crucial for pushing this manuscript across the finish
line. Martin, Fiona and Renata would like to thank the three reviewers of this
manuscript for their very thorough and extremely helpful comments, as well as
the editors of this special issue, Lorenzo Beltrame and Christine Hauskeller, for
their excellent and insightful guidance.


References

Association of Canadian Academic Healthcare Organizations (ACAHO) (2007)
   Moving at the Speed of Discovery: From Bench to Bedside to Discovery, Ot-
   tawa.
Anderson, S. (2012) Public, Private, Neither, Both? Publicness Theory and the
   Analysis of Healthcare Organisations, in “Social Science & Medicine”, 74 (3),
   pp. 313-322.
Atkinson-Grosjean, J. (2006) Public Science, Private Interests: Culture and
   Commerce in Canada's Networks of Centres of Excellence, Toronto, Univer-
   sity of Toronto Press.
Bioscience Innovation and Growth Team (BIGT) (2004) Bioscience 2015: im-
   proving national health, increasing national wealth, London.
Birch, K. (2017) Rethinking Value in the Bio-Economy: Finance, Assetization,
    and the Management of Value, in “Science, Technology & Human Val-
    ues”, 42 (3), pp. 460-490.
Birch, K. and Tyfield, D. (2012) Theorizing the Bioeconomy: Biovalue, Biocapital,
    Bioeconomics or…What? in “Science, Technology & Human Values”, 38 (3),
    pp. 299-327.
Bok, D.C. (2003) Universities in the Marketplace: The Commercialization of
   Higher Education, Princeton, Princeton University Press.
Bryant, A. and Charmaz, K. (eds.) (2007) The Sage Handbook of Grounded The-
   ory, London, Sage.
Bunton, R. and Jones, L. (2010) Visions of the Public and Private in Public
   Health Genomics: The Case of a Nascent Australian Biobank, in “New Ge-
   netics and Society”, 29 (4), pp. 413-429.
Busby, H. (2004) Blood Donation for Genetic Research: What Can We Learn
154                                                              Tecnoscienza - 9 (2)

      from Donors’ Narratives? in R. Tutton and O. Corrigan (eds.), Genetic Data-
      bases: Socio-ethical Issues in the Collection and Use of DNA, London,
      Routledge, pp. 39-56.
Busby, H. and Martin, P. (2006) Biobanks, National Identity and Imagined
   Communities: The Case of UK Biobank, in “Science as Culture”, 15 (3), pp.
   237-251.
Callon, M. (1998) Introduction: The Embeddedness of Economic Markets in
    Economics, in “The Sociological Review”, 46 (S1), pp. 1-57.
Canadian Institutes of Health Research (CIHR) (2006) CIHR – catalyst for com-
   mercialization, Ottawa.
Canadian Institutes of Health Research (CIHR) (2009) Health research roadmap:
   creating innovative research for better health and healthcare – CIHR’s strate-
   gic plan 2009-10–2013-14, Ottawa.
Carter, P., Laurie, G., and Dixon-Woods, M. (2015) The Social License for Re-
   search: Why Care.Data Ran into Trouble, in “BMJ Journal of Medical Eth-
   ics”, 41 (5), pp. 404-409.
Clarke, A. (2005) Situational analysis: grounded theory after the postmodern turn,
    Thousand Oaks, CA, Sage.
Cooper, M. and Waldby, C. (2014) Clinical Labor: Tissue Donors and Research
   Subjects in the Bioeconomy, Durham, Duke University Press.
Council for Science and Technology (CFST) (2011) The NHS as a Driver for
   Growth: A report by The Prime Minister’s Council for Science and Technol-
   ogy, London.
Dixon-Woods, M. and Ashcroft, R. (2008) Regulation and the Social License for
   Medical Research, in “Medicine, Health Care and Philosophy”, 11 (4), pp.
   381-391.
Dixon-Woods, M. and Tarrant, C. (2009) Why Do People Cooperate with Medi-
   cal Research? Findings from Three Studies, in “Social Science & Medicine”,
   68 (12), pp. 2215-2222.
Dixon-Woods, M., Wilson, D., Jackson, C., Cavers, D. and Pritchard-Jones, K.
   (2008) Human Tissue and ‘the Public’: The Case of Childhood Cancer Tu-
   mour Banking, in “BioSocieties”, 3 (1), pp. 57-80.
Etzkowitz, H. (1983) Entrepreneurial Scientists and Entrepreneurial Universities
   in American Academic Science, in “Minerva”, 21 (2-3), pp. 198-233.
Etzkowitz, H. (1998) The Norms of Entrepreneurial Science: Cognitive Effects of
   the New University-Industry Linkages, in “Research Policy”, 27 (8), pp. 823-
   833.
French, M. and Miller, F.A. (2012) Leveraging the ‘Living Laboratory’: On the
   Emergence of the Entrepreneurial Hospital, in “Social Science & Medicine”,
   75 (4), pp. 717-724.
Government of Canada (2007) Mobilizing science and technology to Canada’s
French, Miller and Axler                                                       155
    advantage. Ottawa, Publishing and Depository Services.
Hauskeller, C. and Beltrame, L. (2016a) The Hybrid Bioeconomy of Umbilical
   Cord Blood Banking: Re-Examining the Narrative of Opposition Between
   Public and Private Services, in “BioSocieties”, 11 (4), pp. 415-434.
Hauskeller, C. and Beltrame, L. (2016b) Hybrid Practices in Cord Blood Bank-
   ing. Rethinking the Commodification of Human Tissues in the Bioeconomy,
   in “New Genetics and Society”, 35 (3), pp. 228-245.
Helmreich, S. (2008) Species of Biocapital, in “Science as Culture”, 17 (4), pp.
   463-78.
Hoeyer, K. (2003) ‘Science is really needed – that’s all I know’: Informed Consent
   and the Non-Verbal Practices of Collecting Blood for Genetic Research in
   Northern Sweden, in “New Genetics and Society”, 22 (3), pp. 229-244.
Hoeyer, K. (2008) The Ethics of Research Biobanking: A Critical Review of the
   Literature, in “Biotechnology and Genetic Engineering Reviews”, 25 (1), pp.
   429-452.
Keating, P. and Cambrosio, A. (2000) Biomedical Platforms, in “Configurations”,
   8 (3), pp. 337-387.
Kerr, A. and Cunningham-Burley, S. (2015) Embodied Innovation and Regula-
   tion of Medical Technoscience: Transformations in Cancer Patienthood, in
   “Law, Innovation and Technology”, 7 (2), pp. 187-205.
Lazonick, W., and Tulum, Ö. (2011) US biopharmaceutical finance and the sus-
   tainability of the biotech business model, in “Research Policy”, 40 (9), pp.
   1170-1187.
Lewis, G. (2004) Tissue Collection and the Pharmaceutical Industry: Investigating
   Corporate Biobanks, in R. Tutton and O. Corrigan (eds.), Genetic Databases:
   Socio-ethical Issues in the Collection and Use of DNA, London, Routledge,
   pp. 181-202.
Lipworth, W. Forsyth, R., Kerridge, I. (2011) Tissue Donation to Biobanks: A
   Review of Sociological Studies, in “Sociology of Health & Illness”, 33 (5), pp.
   792-811.
Miller, F.A. and French, M. (2016) Organizing the Entrepreneurial Hospital: Hy-
    bridizing the Logics of Healthcare and Innovation, in “Research Policy”, 45
    (8), pp. 1534-1544.
Mirowski, P. (2012) The Modern Commercialization of Science Is a Passel of
   Ponzi Schemes, in “Social Epistemology”, 26 (3-4), pp. 285-310.
Mitchell, R. (2012) US Biobank Strategies and Biomedical Immaterial Labor, in
   “BioSocieties”, 7 (3), pp. 224-244.
Mitchell, R. and Waldby, C. (2010) National Biobanks: Clinical Labor, Risk Pro-
   duction, and the Creation of Biovalue, in “Science, Technology & Human
   Values”, 35 (3), pp. 330-355.
Naylor, D., Girard, F., Mintz, J., Fraser, N., Jenkins, T. and Power, C. (2015) Un-
156                                                               Tecnoscienza - 9 (2)

      leashing Innovation: Excellent Healthcare for Canada. Report of the Advisory
      Panel on Healthcare Innovation, Ottawa, Health Canada.
Organisation for Economic Co-operation and Development (OECD) (2006) Cre-
   ation and governance of human genetic research databases, Paris, OECD.
Owen-Smith, J. (2005) Dockets, Deals, and Sagas: Commensuration and the Ra-
  tionalization of Experience in University Licensing, in “Social Studies of Sci-
  ence”, 35 (1), pp. 69-97.
Parry, B. and Greenhough, B. (2018) Bioinformation, Cambridge, Polity Press.
Pisano, G.P. (2006) Science Business: The Promise, The Reality, and the Future
    of Biotech, Cambridge, Harvard Business Press.
Rose, H. (2001) The Commodification of Bioinformation: The Icelandic Health
   Sector Database, London, Wellcome Trust.
Sharp, L. (2000) The Commodification of the Body and Its Parts, in “Annual Re-
   view of Anthropology”, 29, pp. 287-328.
Slaughter, S., and Leslie, L. L. (1997) Academic Capitalism: Politics, Policies and
    the Entrepreneurial University, Baltimore, The Johns Hopkins University
    Press.
Star, S.L. and Griesemer, J.R. (1989) Institutional Ecology, ‘Translations’ and
    Boundary Objects: Amateurs and Professionals in Berkeley’s Museum of Ver-
    tebrate Zoology, 1907-1937, in “Social Studies of Science”, 19 (3), 387-420.
Sunder Rajan, K. (2006) Biocapital, Durham, Duke University Press.
Timmons, S. and Vezyridis, P. (2017) Market-driven Production of Biospecimens
   and the Role of NHS Hospital-Led Biobanks, in “Sociology of Health & Ill-
   ness”, 39 (7), 1242-1257.
Tupasela, A. and Snell, K. (2012) National Interests and International Collabora-
   tion: Tensions and Ambiguity Among Finns Towards Usages of Tissue Sam-
   ples, in “New Genetics and Society,” 31 (4), pp. 424-441.
Tupasela, A., Snell, K., Cañada, J.A. (2015) Constructing Populations in Biobank-
   ing, in “Life Sciences, Society and Policy”, 11 (5), pp. 1-18.
Turner, A., Dallaire-Fortier, C., and Murtagh, M.J. (2013) Biobank Economics
   and the ‘Commercialization Problem’, in “Spontaneous Generations: A Jour-
   nal for the History and Philosophy of Science”, 7 (1), pp. 69-80.
Tutton, R. (2002) Gift Relationships in Genetics Research, in “Science as Cul-
   ture”, 11 (4), pp. 523-542.
Tutton, R. (2004) Person, Property and Gift: Exploring Languages of Tissue Do-
   nation to Biomedical Research, in R. Tutton and O. Corrigan (eds.) Genetic
   Databases: Socio-ethical Issues in the Collection and Use of DNA, London,
   Routledge, pp. 19-38.
Tutton, R. (2007) Banking Expectations: The Promises and Problems of Bi-
   obanks, in “Personalized Medicine”, 4 (4), pp. 463-469.
French, Miller and Axler                                                     157
Wainwright, S., Michael, M., Williams, C. (2009) Shifting Paradigms? Reflections
   on Regenerative Medicine, Embryonic Stem Cells and Pharmaceuticals, in
   “Sociology of Health & Illness”, 30 (6), pp. 959-974.
Waldby, C. (2000) The Visible Human Project: Informatic Bodies and Posthu-
   man Medicine, London, Routledge.
Waldby, C. (2002) Stem Cells, Tissue Cultures and the Production of Biovalue, in
   “Health: An Interdisciplinary Journal for the Social Study of Health, Illness
   and Medicine”, 6 (3), pp. 305-323.
Waldby, C. (2009) Biobanking in Singapore: Post-developmental State, Experi-
   mental Population, in “New Genetics and Society”, 28 (3), pp. 253-265.
Waldby, C. and Mitchell, R. (2006) Tissue Economies: Blood, Organs, and Cell
   Lines in Late Capitalism, Durham, NC: Duke.




     1
       According to one of the biobanks we studied, for example, 92% of referred
patients agreed to participate.
     2
       The strong distinction between tangible and intangible goods here could be
likened to the equally problematic distinction sometimes drawn between material-
ity and immateriality, tissue and data, and so on.
