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Introduction
Published in Shirley Sun, Socio-economics of Personalized Medicine in Asia, 2016
The approval of BiDil by the US FDA as the first “ethnic” drug to treat heart failure in self-identified African Americans is a case in point. BiDil was seen to be a significant step toward personalized medicine (Stein, 2005). Yet, upon closer inspection, BiDil is not a pharmacogenomic drug. It is a combination of two generic drugs, hydralazine and isosorbide dinitrate, intended to treat all people suffering from heart failure. Both drugs have been used to treat heart failure in people of all races (U.S. Food and Drug Administration, 2005). Race was the key factor that ensured the success of BiDil even though there were no concrete trials or research conducted to prove its superior efficacy for African Americans compared to other races (Roberts, 2011; Kahn, 2013).
Cultural Economy of Racialized Pharmaceuticals in the U.S
Published in Ann H. Kelly, P. Wenzel Geissler, The Value of Transnational Medical Research, 2013
This chapter takes as its central focus the drug BiDil, which was approved by the U.S. Food and Drug Administration (FDA) in 2005 with the controversial indication for “heart failure in self-identified black patients.” BiDil was released amid a flurry of hype and outrage, yet there has been scant analysis of its subsequent commercial failure. To understand the appeal and ultimate unpalatibility of BiDil, we need to go beyond the conventional critiques of the drug, which decry the reification of race in its indication and the pharmaceutical company’s efforts to profiteer from it. Inspired by Kelly and Geissler’s call for “transcending dichotomies between the economic and the moral” (Chapter 1 of this book), I argue that we need to pay more attention to the productive yet unresolved tensions between consumerist and civil rights claims.
Materialized Oppression in Medical Tools and Technologies
Published in The American Journal of Bioethics, 2023
Shen-yi Liao, Vanessa Carbonell
And then there are tools and technologies that are primarily used by patients and primarily affect patients. Cardiac devices (Dhruva and Redberg 2012) and tissue repair meshes (Menchen, Wein, and Smith 2012) display gender biases similar to ASR hip implants.’ Fitness trackers that use light-based technologies, unsurprisingly, exhibit racial biases similar to pulse oximeters’ (Shcherbina et al. 2017). When corporate wellness programs incentivize the use of fitness trackers by employees, these devices recapitulate the way spirometers were used to validate miners’ claims to disability compensation, except in reverse. Drugs can also materialize biases: the controversy over BiDil, a prescription drug specifically marketed to Black patients with heart failure, illustrates the costs—and, some might argue, benefits—of racialized medicine (Kahn 2012; Roberts 2011).
“Racialized Disablement” as a Key Heuristic for Addressing Racism in Bioethics
Published in The American Journal of Bioethics, 2022
While challenging assumptions concerning race and working to address these in practice is key to building individual networks that can begin to structurally address systemic problems, re-conceptualizing race is incomplete without understanding its imbrication with disability and processes of disablement. In my own work I have proposed racialized disablement as a key heuristic for understanding the processes by which structures of racism and ableism work together to produce populations wherein social and material harms concentrate (Valentine 2021). Take for example higher rates of heart failure in the African American population and the FDA’s endorsement of BiDil in 2005 as a race-based drug made to address the supposedly “different—and implicitly substandard—physiology of the heart, attributable to some unknown but inherent biological factor” (Ehlers and Krupar 2019, 53). Taken at face value, African Americans were simply assumed to have weaker hearts, a function of the race idea reifying race and working to justify a social schema assuming an inferior status and therefore lesser worth of black individuals relative to white individuals. Assuming a health gap by virtue of an implicit value gap neglects to comprehend how both disability and disablement interact with race to manifest racism. In chalking heart failure up to an inherent biological or genetic factor, blackness is assumed as already disabling such that “black disability” becomes redundant. Additionally, since black heart failure is not biological or genetic in origin but biological in effect given the impact of structural racism in producing compounding stresses related to holding a lower status in society, endorsing heart failure as inherent to the black body eclipses the sociopolitical production of disablement by way of the slow violence of structural racism. Recuperating an analysis of disability and disablement within our analyses of racism is key to transforming the operation of the race idea in contemporary bioethical practice. We need to acknowledge and account for how racism and ableism are historically and presently intertwined.