ABSTRACT
Does genome-based precision medicine live up to its promise of fixing the problems of race-based medicine? In Chapter 5, we suggest that it is important to distinguish between pharmacogenomic drug efficacy studies/testing versus pharmacogenomic toxicity studies/testing in answering this question. The majority of clinicians and clinician-scientists we interviewed highlighted the limitations of pharmacogenomic drug toxicity testing in diagnosis, management, and prevention of ADRs, partly because drug-related toxicity is mostly a function of the interaction between genetic and environmental factors. Moreover, we found evidence of racialization of pharmacogenomic drug toxicity studies. Such racialization of genetic variants shaping drug toxicities merits our attention, as such genetic variants are germline variants (as opposed to somatic variants influencing drug efficacy) that can be transmitted across generations. Some interviewees highlighted the issues with using racially/ethnically framed probability statements about possible drug toxicities in clinical care. Furthermore, instead of fixing the problem of race-based medicine, public health officials’ or health economists’ cost-effectiveness studies sometimes contribute to such racialization, and we present findings that show that national populations have also been used as if they were genetically homogeneous.
