<p><p>Pandemic diseases have a nasty history of racialization. COVID-19 is no exception. Beyond the obvious racist invocations of the "China virus" or the "Wuhan Flu" are subtler racializing dynamics that are often veiled in more benign motives but are nonetheless deeply problematic. The racialization of COVID-19 proceeded along two distinct trajectories each of which threatened to reinforce inaccurate biologized conceptions of race while diverting attention from the social, legal, and political forces historically structuring race-based health disparities. First, early on as significant racial disparities in disease incidence and mortality became evident, a frame of race-based genetic difference came to the fore as a possible explanation. Second, as vaccine development ramped up there came widespread calls for racially "diversifying" clinical trials for the vaccines being tested. The rationales for such diversification were varied but tended to reinforce genetic frames of racial difference. Most common was the assertion (without substantial evidence) that vaccines might work differently in Black or Brown bodies and so racial diversity in trials was imperative for reasons of safety and efficacy. Derrick Bell cautioned 20 years ago that "the concept of diversity … is a serious distraction in the ongoing efforts to achieve racial justice." (Derrick Bell, <i>Diversity's Distractions</i>, 103 Colum. L. Rev. 1622, 1622 (2003).) This article explores the dynamics of how the concept of "diversity" racialized responses to COVID-19 and considers their broader implications for understanding and responding to racial disparities in the face of pandemic emergencies and beyond. In the short term, vaccine developers did a decent job of enrolling minorities in their clinical trials and the vaccines have proven to have the same safety and efficacy across races. In the long term, diversity in the biomedical context of pandemic response not only distracts attention from important structural causes of health injustice, but it also focuses attention on the genetics of disparities in a manner that has the potential to reinforce pernicious and false ideas of essential biological difference among racial groups. This article argues that an uncritical embrace of the idea of diversity in analyzing and responding to emergent health crises has the potential to distract us from considering deeper historical and structural formations contributing to racial health disparities. It proceeds first by exploring the dynamics through which initial responses to racial disparities in COVID-19 became geneticized. It will then move on to unpack the rationales for such racialization, examine their merits (or lack thereof), and consider their implications for developing an equitable response to pandemic emergencies. The next section will examine the subsequent racialization of clinical trials for COVID-19 vaccines through the concept of "diversity." It then moves on to explore how the gene
{"title":"Diversity's Pandemic Distractions.","authors":"Jonathan Kahn","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Pandemic diseases have a nasty history of racialization. COVID-19 is no exception. Beyond the obvious racist invocations of the \"China virus\" or the \"Wuhan Flu\" are subtler racializing dynamics that are often veiled in more benign motives but are nonetheless deeply problematic. The racialization of COVID-19 proceeded along two distinct trajectories each of which threatened to reinforce inaccurate biologized conceptions of race while diverting attention from the social, legal, and political forces historically structuring race-based health disparities. First, early on as significant racial disparities in disease incidence and mortality became evident, a frame of race-based genetic difference came to the fore as a possible explanation. Second, as vaccine development ramped up there came widespread calls for racially \"diversifying\" clinical trials for the vaccines being tested. The rationales for such diversification were varied but tended to reinforce genetic frames of racial difference. Most common was the assertion (without substantial evidence) that vaccines might work differently in Black or Brown bodies and so racial diversity in trials was imperative for reasons of safety and efficacy. Derrick Bell cautioned 20 years ago that \"the concept of diversity … is a serious distraction in the ongoing efforts to achieve racial justice.\" (Derrick Bell, <i>Diversity's Distractions</i>, 103 Colum. L. Rev. 1622, 1622 (2003).) This article explores the dynamics of how the concept of \"diversity\" racialized responses to COVID-19 and considers their broader implications for understanding and responding to racial disparities in the face of pandemic emergencies and beyond. In the short term, vaccine developers did a decent job of enrolling minorities in their clinical trials and the vaccines have proven to have the same safety and efficacy across races. In the long term, diversity in the biomedical context of pandemic response not only distracts attention from important structural causes of health injustice, but it also focuses attention on the genetics of disparities in a manner that has the potential to reinforce pernicious and false ideas of essential biological difference among racial groups. This article argues that an uncritical embrace of the idea of diversity in analyzing and responding to emergent health crises has the potential to distract us from considering deeper historical and structural formations contributing to racial health disparities. It proceeds first by exploring the dynamics through which initial responses to racial disparities in COVID-19 became geneticized. It will then move on to unpack the rationales for such racialization, examine their merits (or lack thereof), and consider their implications for developing an equitable response to pandemic emergencies. The next section will examine the subsequent racialization of clinical trials for COVID-19 vaccines through the concept of \"diversity.\" It then moves on to explore how the gene","PeriodicalId":73212,"journal":{"name":"Health matrix (Cleveland, Ohio : 1991)","volume":"32 1","pages":"149-213"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9733320/pdf/nihms-1812706.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9184072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Genetic testing is becoming more frequent and the results more complex. Not infrequently, genetic testing conducted for one purpose reveals information about other features of the genome that may be of clinical significance. These unintended findings have been referred to as "incidental" or "secondary" findings. In 2013, the American College of Medical Genetics ("ACMG") recommended that clinical laboratories inform people if their genetic analyses indicate that they have certain secondary mutations. These mutations were selected because they probably cause a serious disease, which is treatable, and may go undetected. The ACMG's recommendations galvanized critical responses by the genetics and ethics community. One of the most important open questions concerns the scope of negligence liability for clinical laboratories if they failed to provide any of these SFs to patients who never requested them. To answer this question, this article argues that while there might be an ethical or professional obligation to share knowledge about these specific genetic mutations, laboratories should not be subject to tort liability for failure to share secondary findings directly with patients.
基因检测变得越来越频繁，结果也越来越复杂。通常情况下，为一个目的而进行的基因检测会揭示出可能具有临床意义的基因组其他特征的信息。这些意外发现被称为“偶然的”或“次要的”发现。2013年，美国医学遗传学学院（American College of Medical Genetics，简称ACMG）建议，如果患者的基因分析表明他们有某些继发性突变，临床实验室应告知患者。选择这些突变是因为它们可能会导致一种严重的疾病，这种疾病是可以治疗的，而且可能不会被发现。ACMG的建议引起了遗传学和伦理界的强烈反应。一个最重要的悬而未决的问题是，如果临床实验室未能向从未要求提供这些sf的患者提供任何这些sf，他们的过失责任范围是什么。为了回答这个问题，本文认为，虽然分享这些特定基因突变的知识可能有道德或专业义务，但实验室不应因未能直接与患者分享次要发现而承担侵权责任。
{"title":"Needles, Haystacks and Next-Generation Genetic Sequencing.","authors":"Teneille R Brown","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Genetic testing is becoming more frequent and the results more complex. Not infrequently, genetic testing conducted for one purpose reveals information about other features of the genome that may be of clinical significance. These unintended findings have been referred to as \"incidental\" or \"secondary\" findings. In 2013, the American College of Medical Genetics (\"ACMG\") recommended that clinical laboratories inform people if their genetic analyses indicate that they have certain secondary mutations. These mutations were selected because they probably cause a serious disease, which is treatable, and may go undetected. The ACMG's recommendations galvanized critical responses by the genetics and ethics community. One of the most important open questions concerns the scope of negligence liability for clinical laboratories if they failed to provide any of these SFs to patients who never requested them. To answer this question, this article argues that while there might be an <i>ethical</i> or <i>professional</i> obligation to share knowledge about these specific genetic mutations, laboratories <i>should not be subject to tort liability</i> for failure to share secondary findings directly with patients.</p>","PeriodicalId":73212,"journal":{"name":"Health matrix (Cleveland, Ohio : 1991)","volume":"28 1","pages":"217-268"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12981692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147469897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Different but Same: A Call for a Joint Pro-Active Regulation of Cross-Border Egg and Surrogacy Markets.","authors":"Sharon Bassan","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":73212,"journal":{"name":"Health matrix (Cleveland, Ohio : 1991)","volume":"28 1","pages":"323-374"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6329471/pdf/nihms961870.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41156004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"SNEAKING AROUND THE CONSTITUTION: PRETEXTUAL \"HEALTH\" LAWS AND THE FUTURE OF ROE V. WADE.","authors":"Nancy Northup","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":73212,"journal":{"name":"Health matrix (Cleveland, Ohio : 1991)","volume":"26 ","pages":"1-16"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34548547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"THE \"UBERIZATION\" OF HEALTHCARE: THE FORTHCOMING LEGAL STORM OVER MOBILE HEALTH TECHNOLOGY'S IMPACT ON THE MEDICAL PROFESSION.","authors":"Fazal Khan","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":73212,"journal":{"name":"Health matrix (Cleveland, Ohio : 1991)","volume":"26 ","pages":"123-72"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34548552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Punishing pregnant women increasingly serves as a litmus test in political discourse, inviting more than a metaphor about state sanctioned violence targeted at women. In 2016, candidates for the United States presidency threatened to defund Planned Parenthood if elected and a leading candidate promised he would "punish" pregnant women who seek abortions. Other presidential candidates urged that even victims of rape and incest should be forced to carry their pregnancies to term, imposing yet another penalty or strike against sexually violated women and girls. Local legislatures and governors show equal contempt for and desire to penalize women in their states. In Utah, Gov. Gary Herbert took up the call to use a "very strong stick" in policing reproduction by signing into law the Criminal Homicide and Abortion Revisions Act, which applies only to pregnant women. The law seeks to punish pregnant women who "knowingly" commit acts that might result in miscarriages. In 2011, Texas Rep. Doug Miller authored and introduced a bill in his state legislature that would make it a felony to ingest any controlled substance during pregnancy. Wisconsin's legislature passed a law that forces pregnant women to receive vaginal probes as a pre-condition to receiving an abortion. To obtain an abortion without undergoing the vaginal probe is a punishable violation of law. Some women's groups compare vaginal ultrasound laws such as that in Wisconsin to state sanctioned rape with a rod. Other legislative efforts include establishing personhood in embryos and fetuses. Many of the laws seeking to punish pregnant women and regulate their pregnancies introduce criminal sanctions into gestational conduct, broadly criminalizing any behavior that could harm fetal health. All of these laws selectively target pregnant women.
惩罚孕妇越来越多地成为政治话语中的试金石，而不仅仅是一个关于国家批准的针对女性的暴力的隐喻。2016年，美国总统候选人威胁说，如果当选，将取消对计划生育组织的资助，一名主要候选人承诺，他将“惩罚”寻求堕胎的孕妇。其他总统候选人主张，即使是强奸和乱伦的受害者也应该强制怀孕，对性侵犯的妇女和女孩施加另一种惩罚或罢工。地方立法机构和州长对本州的妇女表现出同样的蔑视和惩罚的欲望。在犹他州，州长加里·赫伯特(Gary Herbert)响应号召，将只适用于孕妇的《刑事杀人和堕胎修订法案》(Criminal Homicide and Abortion Revisions Act)签署为法律，要求对生育问题采取“非常强硬的政策”。该法律旨在惩罚那些“故意”做出可能导致流产的行为的孕妇。2011年，德克萨斯州众议员道格·米勒(Doug Miller)在州立法机构起草并提出了一项法案，将怀孕期间摄入任何受管制物质定为重罪。威斯康星州立法机构通过了一项法律，强制孕妇接受阴道检查作为堕胎的先决条件。未经阴道探查而堕胎是应受惩罚的违法行为。一些妇女组织将威斯康辛州的阴道超声法与国家批准的用棍子强奸相比较。其他立法努力包括确立胚胎和胎儿的人格。许多旨在惩罚孕妇和规范其怀孕的法律将刑事制裁纳入妊娠行为，将任何可能损害胎儿健康的行为笼统地定为刑事犯罪。所有这些法律都选择性地针对孕妇。
{"title":"THE PREGNANCY PENALTY.","authors":"Michele Goodwin","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Punishing pregnant women increasingly serves as a litmus test in political discourse, inviting more than a metaphor about state sanctioned violence targeted at women. In 2016, candidates for the United States presidency threatened to defund Planned Parenthood if elected and a leading candidate promised he would \"punish\" pregnant women who seek abortions. Other presidential candidates urged that even victims of rape and incest should be forced to carry their pregnancies to term, imposing yet another penalty or strike against sexually violated women and girls. Local legislatures and governors show equal contempt for and desire to penalize women in their states. In Utah, Gov. Gary Herbert took up the call to use a \"very strong stick\" in policing reproduction by signing into law the Criminal Homicide and Abortion Revisions Act, which applies only to pregnant women. The law seeks to punish pregnant women who \"knowingly\" commit acts that might result in miscarriages. In 2011, Texas Rep. Doug Miller authored and introduced a bill in his state legislature that would make it a felony to ingest any controlled substance during pregnancy. Wisconsin's legislature passed a law that forces pregnant women to receive vaginal probes as a pre-condition to receiving an abortion. To obtain an abortion without undergoing the vaginal probe is a punishable violation of law. Some women's groups compare vaginal ultrasound laws such as that in Wisconsin to state sanctioned rape with a rod. Other legislative efforts include establishing personhood in embryos and fetuses. Many of the laws seeking to punish pregnant women and regulate their pregnancies introduce criminal sanctions into gestational conduct, broadly criminalizing any behavior that could harm fetal health. All of these laws selectively target pregnant women.</p>","PeriodicalId":73212,"journal":{"name":"Health matrix (Cleveland, Ohio : 1991)","volume":"26 ","pages":"17-39"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34548548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"HOBBY LOBBY, BIRTH CONTROL, AND OUR ONGOING CULTURAL WARS: PLEASURE AND DESIRE IN THE CROSSFIRES.","authors":"Robin West","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":73212,"journal":{"name":"Health matrix (Cleveland, Ohio : 1991)","volume":"26 ","pages":"67-107"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34548549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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