1st Edition

The Color of Precision Medicine

By Shirley Sun, Zoe Ong Copyright 2024
    160 Pages 1 B/W Illustrations
    by Routledge

    Will genome-based precision medicine fix the problem of race/ethnicity-based medicine? To answer this question, Sun and Ong propose the concept of racialization of precision medicine, defined as the social processes by which racial/ethnic categories are incorporated (or not) into the development, interpretation, and implementation of precision medicine research and practice.

    Drawing on interview data with physicians and scientists in the field of cancer care, this book addresses the following questions: Who are the racializers in precision medicine, how and why do they do it? Under what conditions do clinicians personalize medical treatments in the context of cancer therapies? The chapters elucidate different ways in which racialization occurs and reveal that there exists an inherent contradiction in the usage of race/ethnicity as precision medicine moves from bench to bedside. The relative resources theory is proposed to explain that whether race/ethnicity-based medicine will be replaced by genomic medicine depends on the resources available at the individual and systemic levels. Furthermore, this book expands on how racialization happens not only in pharmacogenomic drug efficacy studies, but also in drug toxicity studies and cost-effectiveness studies.

    An important resource for clinicians, researchers, public health policymakers, health economists, and journalists on how to deracialize precision medicine.

    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


    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



    3. Trans-National colors: Race, Ethnicity and Genomic Science in the United States of America, Canada and Singapore


    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?


    4. The “relative resources” model: Heterogeneity of resources and the racialization of precision medicine


    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



    5. Pharmacogenetic/Pharmacogenomic Drug Toxicity Studies, Race/Ethnicity and Managing Adverse Drug Reactions in the Clinic: Ongoing Tensions


    Examples of racialised pharmacogenomic studies in the US, Canada and Singapore


    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. 



    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? 




    Science communication by scientists and journalists

    Medical education

    What should different stakeholders take away from this book?


    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?


    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.