Socio-economics of Personalized Medicine in Asia

211 Pages·2017·1.06 MB·English

by  Shirley Sun

Socio-economics of Personalized
Medicine in Asia
The second decade of the twenty-frst century has witnessed a surging interest
in personalized medicine with the concomitant promise to enable more precise
diagnosis and treatment of disease and illness, based upon an individual’s unique
genetic makeup.
In this book, my goal is to contribute to a growing body of literature on per-
sonalized medicine by tracing and analyzing how this feld has blossomed in Asia.
In so doing, I aim to illustrate how various social and economic forces shape the
co-production of science and social order in global contexts. This book shows
that there are inextricable transnational linkages between developing and devel-
oped countries and also provides a theoretically guided and empirically grounded
understanding of the formation and usage of particular racial and ethnic human
taxonomies in local, national and transnational settings.
Shirley Sun is an Associate Professor of Sociology at Nanyang Technological
University (NTU), Singapore. Her main research interests are population stud-
ies, social inequalities, citizenship and immigration, economic development and
social reproduction, and science, technology, and society.
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Socio-economics of
Personalized Medicine
in Asia
Shirley Sun
First published 2017
by Routledge
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© 2017 Shirley Sun
The right of Shirley Sun to be identifed as author of this work has
been asserted by her in accordance with sections 77 and 78 of the
Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or
reproduced or utilised in any form or by any electronic, mechanical,
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British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging-in-Publication Data
Names: Sun, Shirley, author.
Title: Socio-economics of personalized medicine in Asia / by Shirley Sun.
Description: New York : Routledge, 2017. | Series: Routledge studies
in the sociology of health and illness | Includes bibliographical
references and index.
Identifers: LCCN 2016005951
Subjects: LCSH: Personalized medicine—Social aspects—Asia. |
Personalized medicine—Economic aspects—Asia. | Social
medicine—Asia. | Medical economics—Asia.
Classifcation: LCC RA525. S86 2017 | DDC 362.1095—dc23
LC record available at http://lccn.loc.gov/2016005951
ISBN: 978-1-138-93383-5 (hbk)
ISBN: 978-1-315-53717-7 (ebk)
Typeset in Galliard
by Apex CoVantage, LLC
For Alexander and Troy
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Contents
Acknowledgments xi
1 Introduction 1
Personalized medicine and population-based research and
development 1
What is a population? Race and genetics in North America 2
Personalized medicine, pharmacogenomics, and
pharmacoethnicity 4
Why Asia? 6
Time, space, and the emergent other 6
Genomics in Asia and the unfolding dynamics of othering 8
Current research infrastructure and development concerning
personalized medicine in Asia 10
Existing social-science studies of science and medicine
performed in Asia 13
The illuminating question could be, when are you from? 14
What is at stake when populations are ethnically or racially
labeled? 15
Chapter outline 16
2 Regionalism and the study of human genetic variation in
a transnational context: Asianism, nationalism, and the
racialization of ethnicity 25
Introduction 25
The fundamental question of, when are you from? 26
Once upon a time: the unfolding character of the
“Japanese” category 27
Effects of Japanese colonialism and regional integration
on the notion of “Japanese” 28
viii Contents
Resisting being “othered”: scientists in Asia defne “Asian”
genome diversity 31
Ethnicity as a proxy for genetic diversity and the molecularization
of ethnicities in Asia 35
Conclusion 41
3 Capitalizing on being “othered”: precision medicine and
race in the context of a globalized pharmaceutical industry 47
Introduction 47
Saving IRESSA 52
The larger signifcance of the story of IRESSA 55
Racializing clinical trials as a routine phenomenon 58
Local transformations 59
Pharmacogenomics, race, and post-marketing clinical trials 61
Conclusion 69
4 Managing otherness: genomics and public health policy in
Singapore 74
Introduction 74
Population aggregate data, ethnicity, and post-market drug
vigilance 74
Irinotecan and UGT1A1 genotyping 75
Carbamazepine and HLA-B*1502 genotyping 77
Analysis of the prevailing practices noted above 80
The historical emergence of “Malay” as a group during the
precolonial era 81
“Malayness” during the colonial era 82
“Malayness” in the Malay Peninsula in the postcolonial era 90
The case of the Malay in Singapore 92
Conclusion 94
5 Cancer genomics in clinics 98
Introduction 98
Using ethnicity or race as a basis of clinical decision-making 98
Personalized medicine in clinical practice: drug effcacy 105
Personalized medicine in clinical practice: drug toxicities 110
Personalized medicine in clinical practice: preventive
medicine 113
Conclusion 118
Contents ix
6 Socio-economic factors and ethical dilemmas in
personalized medicine provision 120
Introduction 120
Genome-based personalized medicine is effective but not curative;
moreover, it can be prohibitively expensive 120
Should the cost of a cancer drug be part of the treatment
decisions? 122
Who should be expected to interpret genetic tests when cancer is a
“context-dependent manifestation”? 130
Privacy concerns and the potential for genetic discrimination at
the level of the individual and the group 135
Should genome-based pharmaceuticals be the primary approach to
treating cancer? 139
Conclusion 142
7 Conclusion: personalized medicine and population-based
genetic/genomic studies 146
The defnition of population in population-based genetic studies is
context-dependent 148
The defnition of a population is not only context-dependent but
also fuid and arbitrary 151
The regional racialization of genetics/genomics and the
molecularization of ethnicity in Asia 156
The specter of ethnic medicine 158
Cancer genomics in the clinic 159
Bioethics in practicing personalized medicine 160
Upstream engagement and regulatory guidance 163
Apendices 171
Appendix A. A brief socio-history of ten societies in Asia 171
Appendix B. Key characteristics of the scientists and clinician
scientists interviewed 172
Appendix C. Eugenic policies and practices in selected countries
in Asia 173
Appendix D. Is IRESSA available and subsidized in the ten
societies that participated in the HUGO PASNP? 179
Appendix E. Review of the Singapore Ministry of Health
Standard Drug List (SDL) 187
Index 191