ABSTRACT
This chapter examines the socio-technical infrastructures underpinning personalised medicine (PM), framing them as dynamic, value-laden systems rather than neutral technical arrangements. It explores how PM’s data-driven ambitions rely on extensive material and digital infrastructures – ranging from biobanks and genomic databases to digital platforms and interoperability standards – and how these systems are shaped by political, economic, and cultural visions. Using two case studies – the US All of US initiative and the EU’s Virtual Human Twin projects – this chapter shows how infrastructuring is a continuous process of building on existing ‘installed bases’, reproducing or reshaping past priorities and inequalities. It analyses how visions, policymaking, and regulatory frameworks performatively create conditions for certain futures, privileging data-intensive approaches while raising questions of inclusion, access, and equity. The discussion reveals tensions between the promise of participation and the reality of unequal benefits, as well as how infrastructural choices reconfigure foundational concepts like evidence, risk, and patient empowerment. Ultimately, this chapter highlights that PM infrastructures are as much about whose visions and interests are embedded in them as they are about technical capability, setting the stage for deeper inquiry into PM’s publics in the next chapter.
