The Color of Precision Medicine

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.

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?