From Disparity to Difference : How Race-Specific Medicines May Undermine Policies to Address Inequalities in Health Care

On June 23, 2005, the U.S. Food and Drug Administration (FDA) formally approved the heart failure drug BiDil to treat heart failure in self-identified black patients. The drug itself is not actually new; it is merely a combination of two generic drugs that have been used to treat heart failure for over a decade. BiDil's newness derives primarily from its public presentation as the world's first ethnic drug. This analysis begins with a consideration of the race-specific clinical trials that preceded the FDA approval and then moves on to elaborate upon some of the broader implications of BiDil in the context of genomic medicine and the politics of heath care. It briefly relates the story of how law and commerce played a central role in the emergence of BiDil as an ethnic drug. Then it explores the strategic reification of race as genetic in the context of BiDil and connects the drug to larger issues concerning genetics and the politics of difference in health care and perhaps beyond. In particular, the Article explores three areas in this process of reification: 1) the statistical manipulation of racial difference in drug development; 2) the conflation of racial difference with genetics; and 3) the relationship between genetic explanations of difference, market ideologies, and backlash against state action to redress racial injustice