Is there evidence for the racialization of pharmaceutical regulation? Systematic comparison of new drugs approved over five years in the USA and the EU

Race in clinical trials in Sweden: How regulatory and medical standards in clinical research trump the post-racial discourse

The post-racial discourse that permeates many Western European countries depicts society as having moved beyond race concepts and classifications. This article focuses on Sweden, a country that, in line with the post-racial thinking, declares race to be an offensive and unscientific concept. The article investigates what happens when this post-racial discourse meets clinical research standards that encourage, if not demand, the collection of data on patient race. Through an analysis of the reporting of patient race in 76 multinational trials with at least one study site in Sweden, and a review of the regulatory and medical standards and trial documents that direct the collection of patient race in trials, we show how race classification is kept intact in trials despite conflicting with post-racial norms and conventions. Notably, our findings diverge from the way racialisation is typically assumed to work in Sweden and related countries. We argue this is possible because the two incompatible understandings of race are 'distributed' (Mol, 2002, The body multiple: Ontology in medical practice, Duke University Press) among different social worlds. The distribution, we propose, is upheld through the paucity of major debate on why and how race classification should be carried out in clinical trials in Europe as this allows contradictions to remain unspoken.

Interethnic differences in drug response: projected impact of genetic variations in the Saudi population

Ethnicity is known to have an impact on drug responses. This is particularly important for drugs that have a narrow therapeutic window, nonlinearity in pharmacokinetics and are metabolized by enzymes that demonstrate genetic polymorphisms. However, most clinical trials are conducted among Caucasians, which might limit the usefulness of the findings of such studies for other ethnicities. The representation of participants from Saudi Arabia in global clinical trials is low. Therefore, there is a paucity of evidence to assess the impact of ethnic variability in the Saudi population on drug response. In this article, the authors assess the projected impact of genetic polymorphisms in drug-metabolizing enzymes and drug targets on drug response in the Saudi population.

Conceptual unclarity about COVID-19 ethnic disparities in Sweden: Implications for public health policy

The COVID-19 pandemic has shed light on abundant racial and ethnic health disparities in many countries around the world. In Sweden, statistics on COVID-19 mortality and morbidity from both the first and the second wave of the pandemic show that foreign-born individuals have been disproportionately affected, compared to Swedish-born individuals. However, as demonstrated in this article, key stakeholders including politicians, public authorities, mainstream media, and medical researchers do not draw on the same explanatory framework when conceptualizing the health disparity. Probing the different discourses that were articulated through oral and written accounts during the first wave, the article identifies three different frameworks of how ethnic health disparities in relation to COVID-19 were understood in Sweden: the socioeconomic framework, the culturalist framework and the biological framework. We discuss the importance of our findings for health policy and argue for continued interrogation of epidemiological knowledge production from a critical vantage point in order to successfully combat health inequalities.

Reductionist methodology and the ambiguity of the categories of race and ethnicity in biomedical research: an exploratory study of recent evidence

In this article, we analyse how researchers use the categories of race and ethnicity with reference to genetics and genomics. We show that there is still considerable conceptual "messiness" (despite the wide-ranging and popular debate on the subject) when it comes to the use of ethnoracial categories in genetics and genomics that among other things makes it difficult to properly compare and interpret research using ethnoracial categories, as well as draw conclusions from them. Finally, we briefly reconstruct some of the biases of reductionism to which geneticists (as well as other researchers referring to genetic methods and explanations) are particularly exposed to, and we analyse the problem in the context of the biologization of ethnoracial categories. Our work constitutes a novel, in-depth contribution to the debate about reporting race and ethnicity in biomedical and health research. First, we reconstruct the theoretical background assumptions about racial ontology which researchers implicitly presume in their studies with the aid of a sample of recent papers published in medical journals about COVID-19. Secondly, we use the typology of the biases of reductionism to the problem of biologization of ethnoracial categories with reference to genetics and genomics.

“Black race”, “Schwarze Hautfarbe”, “Origine africaine”, or “Etnia nera”? The absent presence of race in European pharmaceutical regulation

Current scholarship on race in Europe has described race as an “absent presence”. However, little is known about the dynamics of the absentness and presentness of race, including how various social processes operating at distinct levels (e.g. supranational and national) influence the uses of race and ethnicity concepts. We begin addressing this gap by examining racialised pharmaceutical regulation in the EU and its operationalisation in European countries. We analysed patterns of English-language uses of race and ethnicity terms at the EU level for all new drugs approved in 2014–2018, and systematically compared official translations into 24 languages. We found that “race” was promoted in plain sight and often retained when translated, albeit with much inconsistency across languages, creating peculiar patterns of presentness and absentness of race. Finnish, French, Swedish, and German stood out, as “race” was often translated into ethnicity terms, but even in those languages, “race” lingered despite claims that these countries vehemently opposed “race”. Our findings should inform scholarly and political debates about race, ethnicity, and medicine in Europe that tend to assume, incorrectly, an anti-racialist consensus. There are also policy implications, because prescribers may interpret regulator-approved information about race and ethnicity differently because of inconsistent translations.

Analysis and enhancement of risk management for ethnic differences in antineoplastic drugs in Japan

Background

Risk management in the post-marketing phase is crucial to minimize health problems caused by drugs. Because ethnic factors may affect drug safety, the objective of this study was to explore concrete approaches to reflecting ethnic factors in risk management under multi-regional drug development.

Methods

We assessed Pharmaceuticals and Medical Devices Agency (PMDA) review reports on antineoplastic drugs approved as new molecular entities in the last 10 years to identify any differences in the incidence of adverse drug reactions (ADRs) related to myelosuppression, hepatic impairment, renal impairment, and interstitial lung disease between Japanese and non-Japanese populations. In addition, we investigated how those ADRs were handled in the labeling of each drug.

Results

In total, 44 drugs were available for comparing the incidence of ADRs between Japanese and non-Japanese populations. Of these, 32 drugs had a higher incidence of ADRs in the Japanese population. However, the incidence of ADRs in the Japanese population was described in the labeling for 7 drugs, and only the incidence in the overall population in multi-regional phase III trials was described in the labeling for the remaining 25 drugs. Of these 25 drugs, two drugs were immediately placed under emergency safety control measures after approval because of the high incidence of ADRs in Japanese patients.

Conclusions

For drugs that might cause serious ADRs and with a higher incidence in the Japanese population, information should be provided on the incidence in the Japanese population as well as in the overall population.

Quantifying Diversity and Representation in Pivotal Trials Leading to Marketing Authorization in Europe

BACKGROUND

Following up on a study from 2019, Tufts CSDD collected and analyzed data on demographic disparities and representation in pivotal trials supporting the marketing authorization of novel drugs and biologics approved in Europe between 2007 and 2019.

METHODS

Data were collected from products' EPAR, the EUDRACT database, and other publicly available sources, and compared to indication-specific demographic data or a census estimate. In total, data were collected on 446 drugs and 943 pivotal trials.

RESULTS

Results indicated that gender demographic data were only reported for 80.7% of pivotal trials, and that racial and ethnicity demographic data were reported less often (64.1% and 29.9% of pivotal trials, respectively). Results also indicated that non-white racial identities were under-represented by more than 20% in nearly half or more of pivotal trials.

CONCLUSIONS

Guidelines encouraging the reporting of patient demographic data are insufficient and availability of the data is problematic. The available data suggest that under-representation in pivotal trials is widespread.