Epistemological Pitfalls in the Proxy Theory of Race: The Case of Genomics-Based Medicine

In this article, we discuss epistemological limitations relating to the use of ethno-racial categories in biomedical research as devised by the Office of Management and Budget’s institutional guidelines. We argue that the obligation to use ethno-racial categories in genomics research should be abandoned. First, we outline how conceptual imprecision in the definition of ethno-racial categories can generate epistemic uncertainty in medical research and practice. Second, we focus on the use of ethno-racial categories in medical genetics, particularly genomics-based precision medicine, where ethno-racial identity is understood as a proxy for medically relevant differences among individuals. Notably, extensive criticisms have been made already against the genetic interpretation of races, but, nonetheless, the concept of race remains a key element of contemporary genomics. This motivates us to explore possible reasons why such criticisms may have been ineffective in redirecting attention to other (non-race-based) ways of controlling for human variability. We contend that popular arguments against the idea that human races have a genetic basis, though convincing in many respects, are not sufficient to exclude the pragmatic use of race and ethnicity as proxies for genetic variability related to complex phenotypes. Finally, we provide two further arguments to support the idea that ethno-racial categories are unlikely to provide meaningful insights into medical genetics, which implies that even the interpretation of race as a useful tool to stratify disease risk is unwarranted.