This article analyzes the impact of direct legislation, such as initiatives and referenda, on policies for agro-food and medical biotechnologies. Between 1980 and 2007, citizens around the world voted on biotechnology policies on 25 occasions. The analysis of these referenda and initiatives has shown that the mobilization of the popular initiative has proven to be an institution for successfully promoting more state intervention, in particular for agro-food biotechnology. Direct democracy contributed to opening up the policy-making process for interests critical towards biotechnology and thus helped to produce a more inclusive policy- making process and provided a counterweight to the influence of physicians and research interests on public policies. However, direct legislation also allowed proponents of biotechnology to promote medical research and applications.