Will genome-based precision medicine fix the problem of race/ethnicity-based medicine? To answer this question, Sun and Ong propose the concept of racialization of precision medicine, defined as the social processes by which racial/ethnic categories are incorporated (or not) into the development, interpretation, and implementation of precision medicine research and practice.
Drawing on interview data with physicians and scientists in the field of cancer care, this book addresses the following questions: Who are the racializers in precision medicine, how and why do they do it? Under what conditions do clinicians personalize medical treatments in the context of cancer therapies? The chapters elucidate different ways in which racialization occurs and reveal that there exists an inherent contradiction in the usage of race/ethnicity as precision medicine moves from bench to bedside. The relative resources theory is proposed to explain that whether race/ethnicity-based medicine will be replaced by genomic medicine depends on the resources available at the individual and systemic levels. Furthermore, this book expands on how racialization happens not only in pharmacogenomic drug efficacy studies, but also in drug toxicity studies and cost-effectiveness studies.
An important resource for clinicians, researchers, public health policymakers, health economists, and journalists on how to deracialize precision medicine.
Table of Contents 1 . Introduction Precision medicine (PM): A global phenomenon What is precision medicine? Definitions, sites and scale. Precision medicine as an alternative to race-based medicine What is race-based medicine and racial profiling in medicine? Problems with race-based medicine/racial profiling in medicine Is genome-based precision medicine really the answer? Addressing the debate: Racialization as the key concept Racialization of national census categories Racialization in science (or, scientific racism) in colonial contexts Racialization of medicine in colonial contexts Racialization in medicine in contemporary times In the (post-)Genomic Era: Racialization of human genomic science What is the future of genome-based precision medicine? An empirical examination in cancer care in three post-colonial societies. Chapter outline 2 . Using race to overcome race: An inherent contradiction in precision medicine Introduction Using race to overcome race: understanding an inherent contradiction in translational precision medicin First domain: Searching for the genetic biomarker in scientific research Second domain: Recruiting suitable human subjects for clinical trials Third domain: Medical decision-making in the clinic Conclusion 3. Trans-National colors: Race, Ethnicity and Genomic Science in the United States of America, Canada and Singapore Introduction Is race biological or socially constructed? A brief overview. Where and how do racialization happen in genomic science? Materials for racialization of a population sample and/or patient Issues with the different ways of racialization Perspectives from the genomic science community about the relationship between race and genetics No clear distinction between ethnoracial population groups Genetic heterogeneity within an ethnoracial population group Race as a social construct If race is socially constructed, why are there differences in frequencies of genetic alleles between racial/ethnic groups? If not race, what drives human genomic diversity? Conclusion 4. The “relative resources” model: Heterogeneity of resources and the racialization of precision medicine Introduction The “personalized medicine” versus “racialized medicine” debate “Race is really the poor man’s genomic test”: The relative resources model Financial resources Human and informatics resources Legal and infrastructural resources Implications of the relative resources model Conclusion 5. Pharmacogenetic/Pharmacogenomic Drug Toxicity Studies, Race/Ethnicity and Managing Adverse Drug Reactions in the Clinic: Ongoing Tensions Introduction Examples of racialised pharmacogenomic studies in the US, Canada and Singapore Allopurinol 5-Fluorouracil (5-FU) Cost-effectiveness studies, race/ethnicity and precision medicine Who is Asian and who is Caucasian? Debating race/ethnicity-based pharmacogenetic toxicity data in the clinic Subjective interpretation of drug toxicity risks Toxicity is a multi-factor phenomenon and is not just about genetics Pharmacogenetics/pharmacogenomics studies and pharmaceutical companies are at odds. Conclusion 6 Conclusion What is already known on the topics of race-based medicine, precision medicine, and the molecularization of race? What does this book add to the existing state of the art? What are the arguments and findings in each chapter? How might this study affect research, practice or policy? Research Practice Policy Science communication by scientists and journalists Medical education What should different stakeholders take away from this book? Scientists Physicians/medical doctors Public policy makers Health economists What are the theoretical and empirical contributions of this book? On “racialization” On the nexus of relative resources and racialization of precision medicine On differential racialization What are the tensions with the usage of race/ethnicity in genomic science with medical and public health implications? What are some of the limitations of this study? What are some of the future research projects based on this book?
Shirley Sun is an associate professor of sociology at the Nanyang Technological University (NTU), Singapore. Her research areas are medical sociology and sociology of science, knowledge, and technology. She is the author of “Socio-economics of Personalized Medicine in Asia” (2017, London and New York: Routledge). Zoe Ong is a PhD candidate from the Interdisciplinary Graduate Program at the Wee Kim Wee School of Communication and Information, Nanyang Technological University (NTU), Singapore. With an MSc in biological sciences, her research interests include cancer and genetics, digital health, health communication, and health literacy.
