It is an anthropologist’s nature to always question and engage in critical analysis and thought; to want to make sense of complexity rather than rotate towards simplification. Jonathan Kahn’s concise, clear, and illuminating piece Race in a Bottle: The Story of BiDil and Racialized Medicine in a Post-Genomic Age critically engages with the sphere of biotechnology and scientific inquiry; in doing so, it succinctly brings together themes of race, biopower, capital, and history in a meaningful manner. Kahn exposes the dangers of oversimplification of statistics and social constructions, and more importantly, the ways in which BiDil, a heart failure pill patented specifically for African Americans, privatized, naturalized, and commodified race.
Kahn reinforces the discussion of biology as a social science, warning against the ‘desocialization’ of scientific inquiry (Kahn, 2013: 3). While science is commonly viewed as a prism of objectivity nearly immune to subjectivity, the introduction of race into biomedicine, which is largely regarded as a social construction, becomes problematic. As Kahn explains “race is not a coherent genetic concept; rather, it is best understood as a complex and dynamic social construct” (Kahn, 2013: 2). Indeed, race, “is a language open to all,” it is a vocabulary very much present in the context of every day life (Kahn, 2013: 8). Genetics, biomedicine, and biotechnology, on the other hand, are largely left in the hands of individuals deemed credible, qualified, and logical. When these two spheres collide, the results can be incredibly problematic without the proper framework. Khan writes, “when using race in medical practice, what matters is our shifting understanding of the correlations between such evolving social identities and the economic, political, and environmental conditions to which they may be related” (Kahn, 2013: 13). Yes, race is important in biomedicine, but when it is used as a biological category, it distorts or ignores attempts to address real social and health problems affecting individuals (Kahn, 2013: 70). Since race and racial disparities are realities in health care and in turn affect biology, the same care afforded to genetic data by scientists should be given to racial data that is produced and circulated (Kahn, 2013: 16).
Unfortunately, this care and consideration is not apparent in the case of BiDil. Instead, race is commodified, used to push through a patent and generate revenue. The result, is the marketing of a race-specific drug, which statistically does not affect and treat African Americans any more significantly than whites. In the creation of this “Race in a Bottle” is the idea that “people suffering from African-American-ness” deserve the same special consideration as those suffering from an orphan disease,” that is, that whiteness is the unstated norm; being black is a deviation from that norm (Kahn, 2013: 98). In this way, race is both biologized and pathologized. Kahn raises the widespread and blinding accepted statistic that “African Americans die from heart failure at a rate twice that of White Americans” (Kahn, 2013: 51). Though Kahn highlights the illegitimacy of this statistic, it has almost become naturalized, that is, so accepted it doesn’t even need to be properly cited, and while BiDil is an effective pill in addressing heart failure, a condition which affects approximately five million Americans, it is not effective only in African American populations. Truthfully, NitroMed, the pharmaceutical company to push for the BiDil race-specific patent, “exploited race to facilitate acceptance of high pricing” and “branded race as a medical condition” (Kahn, 2013: 105, 106). Making heart-failure a “different disease” in African Americans is particularly dangerous in light of America’s history (e.g. Tuskegee Study). It should be noted that BiDil was not originally intended as a race-specific drug. Race came into play when there arose an urgency for patent protection. The need to make a profit outweighed faulty data and misconstrued statistics, and more significantly, it ignored implications of using race in a way that made it a biological construct. The approval of the BiDil patent for a drug that would be catered and marketed towards African Americans “racializes intellectual property, transforming it into a terrain for the renaturalization of race as some sort of objective biological category” and “commodifies race as a good to be patented and subject to the dictates of market forces” (Kahn, 2013: 124). The patent was further legitimized by data and statistics, which were insufficient at best. This role played by data can be seen through the lens of race and biopower and is visible in the work of Montoya who discusses the inequitable exchange of data between underprivileged and disadvantaged Mexican Americans who donate blood for research into type two diabetes in return for a free meal and medical referrals, and the millions generated by researchers. Moreover, the manipulation of statistics draws parallels to the ways data can be misconstrued to convict a “criminal” and to align with notions of justice. In the frame of the criminal justice system we have seen how data manipulation, or presentation of favorable aspects, “fails to protect the civil liberties of its citizens” in the name of “the well-being of the society” (Suter, 2010: 374). In the case of BiDil, the startling statistic that “African Americans die from heart failure at a rate twice that of White Americans” is a tactic that plays into societal desires to offer equitable health care (Kahn, 2013: 51). It begs the question whether this use of “blackness” to get a drug to market is an equitable exchange. Are African Americans benefiting from BiDil to the same extent NitroMed is? Is the guise of humanitarian health care strong enough to mask this biologization of race?
We have seen race used as a mechanism for identification, both self-identification and identification by others (think of Foucault’s forms of subjectification), and have seen the ways in which it is rationalized, commodified, and understood within a matrix of ascriptions and assumptions. Narratives of letting die and making live are relevant here. Race as biology, as genetics, is made to live through the production of BiDil. What is dying is a critical awareness of how “racialized biotechnology patents use race…as a technology of classification” (Kahn, 2013: 140). While the patent may protect the economic potential of BiDil and legally “grants the owner the right to exclude others from making, using, or selling the invention for a period of twenty years,” it lays out in the open ideas of whiteness as accepted and blackness as otherness; it appropriates “a new genetic commodity value in race” (Kahn, 2013: 126, 156). By excluding whites from the product in the legal vocabulary, the BiDil patent creates a novelty drug. What Kahn asks for is simple; a greater awareness of race’s growing role in biotechnology because “a disjunction between a rhetorical acknowledgement of racial categories as social and continued practical use of such categories as, in effect, genetic is all too common in biomedical research” (Kahn, 2013: 81). BiDil is an example of the commodification of race itself as biologically manifested in human bodies and it can dangerously allow people to use science to confirm personal beliefs: beliefs that in “blackness” there is danger. Critically, science is not separate from the system. There is a structure and a narrative within which science is embedded; failure to recognize that science does not always possess an inherent infallibility and objectivity is lethal.