Mixed Race Studies

How Personalized Medicine Became Genetic, and Racial: Werner Kalow and the Formations of Pharmacogenetics

Journal of the History of Medicine and Allied Sciences
Volume 68, Number 1, January 2013
pages 1-48
DOI: 10.1093/jhmas/jrr046

David S. Jones, A. Bernard Ackerman Professor of the Culture of Medicine
Harvard University

Physicians have long puzzled over a well-known phenomenon: different patients respond differently to the same treatment. Although many explanations exist, pharmacogenetics has now captured the medical imagination. While this might seem part of the broader interest in all things genetic, the early history of pharmacogenetics reveals the specific factors that contributed to the emergence of genetics within pharmacology. This paper examines the work of one pioneering pharmacologist, Werner Kalow, to trace the evolving intellectual formations of pharmacogenetics and, in particular, the focus on race. Working in the 1950s and 1960s, Kalow made three arguments to demonstrate the relevance of genetics to pharmacology, based on laboratory techniques, analogies to differences between other animal species, and appeals to the logic of natural selection. After contributing to the emergence of the field, Kalow maintained his advocacy for pharmacogenetics for four decades, collecting more evidence for its relevance, navigating controversies about race and science, and balancing genetics against other possible explanations of patient variability. Kalow’s work demonstrates the deep roots of the genetic and racial preoccupations in pharmacology. Understanding this history can restore attention to other explanations of individuality in medical practice, something of increasing importance given the current interest in personalized medicine.

Read the entire article here.

Book review: What’s the use of race? Modern governance and the biology of difference

BioNews
Number 634 (2011-11-21)

Dr. Rachael Panizzo

Decoding the human genome has revealed details of our evolution and patterns of migration across the world. The study of genetic diversity between ethnic groups can help explain the ways in which race influences our biology and susceptibility to disease. It promises to deliver a new era of personalised medicine, where an individual’s unique DNA profile is used to make predictions about their future health; where specialised drugs are tailored to individual patients, based in part on their genetic ancestry.

But what do we mean by ‘race’, exactly? Is race a relevant biological or medical category, and how is it defined in practice?

These issues are considered in the collection of essays What’s the use of race? Modern governance and the biology of difference, edited by Dr Ian Whitmarsh of the University of California San Francisco, and Dr David Jones at the Massachusetts Institute of Technology. The contributors explore the use of race in biomedical research and some of the emerging practical applications in medicine and forensic science. Their diverse and sometimes conflicting perspectives result in an engaging book that highlights the complexity of the issue.
 
Genetics has become the foundation of a new ‘biocitizenship’, where it is our civic duty to know and share our own genetic information and engage with our health at a molecular level. Common genetic make-up replaces common social experience, and group identities are carved along lines of shared genetic traits, ‘reinterpreting existing political identities and creating new ones’, says Professor Dorothy Roberts, from Northwestern University. Social and political categories of difference—such as gender or race…

…In the medical setting, subtle statistical differences are often interpreted as blanket differences between races, and individual patients are assumed to reflect the average characteristics of their race. But Jay Kaufman, associate professor of epidemiology at McGill University, and Professor Richard Cooper, of Loyola University, Chicago, demonstrate that in practice, a patient’s ethnic identity adds little to the diagnosis or prognosis of disease and is rarely medically relevant.

The essays of Professor Jonathan Kahn (Hamline University), and Pamela Sankar, associate professor of bioethics at the University of Pennsylvania emphasise how embedded racial categories are in forensic science, giving examples of DNA fingerprinting and phenotyping. Originally, racial information was used in DNA fingerprinting technology to improve accuracy, but as it has improved substantially, Professor Kahn argues it is now superfluous, irrelevant, and risks perpetuating racial stereotypes – ‘conflating race, genes and violent crime’…

…Should race be used at all in medical research? Many authors argue that its inclusion reifies the concept of race as a fundamental human characteristic. But Dr Kaufmann, Professor Cooper, and Harvard School of Public Health Professor Nancy Krieger suggest race does have a place in biomedical research, as a social category—including information about race or ethnicity is a way of documenting health inequalities, which would otherwise be invisible and ignored….

Read the entire review here.