Capitalizing on Being Othered: Genomic Medicine, Racial Identities and a Globalized Pharmaceutical Industry

This paper critically examines the construction of racially and ethnically-labelled populations in the development of genomic medicine.  In the (post-)genomic era, will medicine be “personalized” according to an individual’s unique genetic makeup or will it be developed and administered in relation to that individual’s racial and ethnic identities?  Before genome-based personalized medicine can be administered in clinical settings, the question is what shapes drug marketing and development.  This paper closely examines the story of Gefitinib (IRESSA, marketed by the pharmaceutical company AstraZeneca), a drug for treating non-small cell lung cancer patients with EGFR mutations. It suggests that the case of IRESSA deserves a closer look, because it has been hailed as an exemplary case of personalized medicine.  It demonstrates that, in some instances, lying just beneath the surface of molecular-based personalized medicine is the reality of racially and ethnically-designated population-based drug development in the context of a globalized pharmaceutical industry.  In addition, this paper analyzes the ways in which some geneticists and medical oncologists in Singapore have capitalized on being “othered” (Said, Orientalism, 1978).  Their empirical pharmacogenomics studies of cancer drug toxicity emphasize ethnic diversity, for instance, by adopting comparisons between “Asians” and “Caucasians” in Phase IV trials.  While previous studies have identified the role of the ethnic niche market in this phenomenon of the medicalization of race (Duster 2007, Lee 2003), this paper suggests that such a phenomenon cannot be fully explained without an understanding of the choices and rationale underlying the cooperation of participating clinical trial centres and doctors.  Most importantly, this paper draws on interview data with geneticists and medical researchers to argue that the definition and identification of “Asians” and “Caucasians” are based on arbitrary criteria.