ESC: English Studies in Canada

In June 2005, the U.S. Food and Drug Administration (FDA) announced its approval of the drug BiDil, designed to treat heart disease in patients who self-identify as African-American exclusively and, with this decision, “race-specific” medicine was established as the fda became the first regulatory body to approve a medication for therapeutic use in a specific racial group. Manufactured by the pharmaceutical corporation NitroMed, BiDil is comprised of two generic drugs, isosorbide dinitrate and hydralazine, which had been commonly prescribed to treat heart failure prior to the creation of BiDil as a “two-in-one” pill (Kahn, “Race” W1). The composition of BiDil is not novel and thus cannot be conceived of as a medical breakthrough. Further, the scientific conduct that paved the way for the fda’s approval of BiDil for use in African-American populations was particularly suspect: the clinical trials conducted by NitroMed to test the effectiveness of BiDil on patients predisposed to heart disease were accessible only to African-American participants (Kahn, “Ethnic Drugs”). By carrying out the trials in this manner, NitroMed was able to guarantee its desired outcome. Unless the drug proved to be ineffective in treating heart disease—an outcome that was extremely unlikely, considering the longstanding proven effectiveness of both isosorbide dinitrate and [End Page 127] hydralazine as separate therapies—it was inevitable that the results of the trials would indicate the successful creation of a race-specific drug since the only participants in the trial were African-American and BiDil was known to be effective in treating heart disease in humans generally. Thus, NitroMed was able to produce results proving the effectiveness of BiDil in African-American populations. As Jonathan Kahn notes:

The trial investigators themselves concede that BiDil will work in people regardless of race. Without a comparison population, the investigators cannot even claim that the drug works differently in African Americans. The only responsible scientific claim that can be made on the basis of these trials is that BiDil works in some people who have heart failure—period.

(“Ethnic Drugs” C3)

For the moment, I will bracket the most obvious objection to NitroMed’s dubious practices: the accusation of essentialism. Although this is inestimably important, it remains a secondary consideration until I contend with the social and political implications of the fda’s approval of BiDil. Thus, rather than putting forth questions concerning the criteria employed by NitroMed for inclusion in their constructed category of “African-Americanness” (recognizing the absurdity of any mode of thinking that puts forth a conception of racial purity), I periodize the emergence of race-specific medicine and draw attention to the particular discursive constructions through which this practice produces meaning.

The problem of race-specific medicine emerges from within a broader framework of a conjuncture in which biopower produces value through the transformation of biology into information at the molecular level. This particular form of power interpellates individuals as biocitizens or health consumers (Roberts) through discourses of risk and responsibility; biopower possesses the generative capacity to produce new forms of what is understood as the common sense of the truth of the biological, thus ensuring a smooth transition to this new form of biopolitics as the calculated management of the productive capacities of molecular forms of life following the revolution in the life sciences industry.

The contemporary biopolitical moment is one in which the life sciences and capitalism are equally interested in, and working together to forge, newly profitable futures for human life through new conceptions of therapeutic specificity as well as new forms of corporate management and intervention; race-specific medicine is but one iteration of this tendency. My discussion of BiDil seeks to reframe the disparity in incidence of heart [End Page 128] disease—a problem that is too often moralized and technologized—as a social and political problem by focusing on the ways in which science and technology produce material shifts that become intelligible through narratives and social discourses that appear as inevitable discoveries rather than as components of larger political projects. These narratives and discourses often emphasize theoretical and technical complexity, which functions to dissociate...