Individualized Medicine as Racial Eugenics: A Critical Appraisal

Overview

The continuing shift towards individualized and personalized medicine in practice and research has been heralded for a vision of patient care tailored to the needs of individuals. However, attuning modern medical practice to the needs of individuals by means of genetic¹ and phenotypic² inference does not necessarily result in a medical practice carried out for the benefit of individuals in a manner independent of socially constructed categories. Categorization on the basis of race, socioeconomic status, (dis)ability, sex, etc. may all enter as forms of self-fulfilling groupings which are concretized in medical practice. This subtlety is often clouded in contemporary clinical implementations of individualized and personalized medicine frameworks, where the use of reductive and genetic data types from socially constructed human populations is implicit. The use of these populations as baselines for determining individual health standards and outcomes uses these data types in a methodologically dependent manner. Applied to an individual, this process can then be used for prognostication of disease and other undesirable characteristics followed by preemptive intervention.³ The subsequent effects of these “preemptive interventions” range greatly but can include behavioral modifications, sexual abstinence, and even suicide. Such effects have consequences with regard to total human diversity and potentialities under current expansions of implementation and scale. Here, I highlight the general and technical procedures underlying these concerns, as well as their processual interplay with racialized identity constructs. I follow with an analysis of outcomes associated with current implementation trends, and examine some of the associated counterarguments. Throughout and in conclusion I engage social ecological thought to provide an alternative framework to this contemporary medical-genetics paradigm. 

Historically, population control and augmentation to “improve” the overall genetic composition of humans to some desired final form has been described as eugenics.⁴ Such ideologies were implemented by various means ranging from coercive sexual abstinence to racialized “nullification of peoples.”⁵ As current individualized and personalized medical initiatives are based on strong genetic and racial components, eugenic tendencies are a widespread and central worry. 

To briefly give an example of what these practices look like in “modern” individualized or personalized medicine, consider the following example where race is used as a “surrogate for social variables”⁶ and then assigned genetic causality. Native Americans are officially categorized as a “race” despite belonging to hundreds of different cultural, ethnic, and national groups. As a result of common histories of dispossession and genocide, there are higher rates of alcoholism among Native Americans, along with higher rates of liver disease. As part of a large genomic sequencing initiative,⁷ genetic similarities in this constructed group are identified as similar alterations in the alcohol dehydrogenase (ADH) gene. These alterations are then given causal status to the group for higher rates of alcoholism and liver disease, even though no such clear population-group boundaries exist in terms of genetic relatedness.These few genetic similarities that do exist, mostly due to similar geographic origins, are then used to claim there are racial genetic underpinnings to alcoholism. These genetic markers will then enter into the medical canon as predictive of liver disease for the next patient of “race X” that is tested. This new patient will be subjected to various forms of intervention to prevent the development of liver disease such as prophylactic medication, behavioral modifications, etc. Other examples of racial genetic constructs that enter this circularity include the “African-American” grouping of variation in the β-globin (HBB) gene (even though this variation is found among many “races,” and the heterzygote form is even protective against certain infectious diseases). 

Those medical conditions therefore perceived as severe or abnormal are then inappropriately assigned causality through heritable genetics. The individual is then subjected to various forms of control or fixing to prevent the spread and larger social effects of this “severe” condition, but where the condition (in this case alcoholism) is a product of the social conditions, creating a perverse circularity of supposed causality and determinism. This approach to individualized or personalized medicine is racialized eugenics–albeit in a new and more nuanced form. 

While varied, current implementation is often through a complex coalescence of governmental, corporate, academic, and financial bureaucracies.⁸ In the United States, such efforts are being coordinated through the National Institutes of Health (NIH)-sponsored All of Us program which aims to sequence one million individual genomes. Various private medical organizations also have their own genome sequencing initiatives, making total counts difficult. China, having bureaucracies that are more centralized, aims for an ambitious goal of 100 million genomes by 2030. Both efforts are well underway. In the United Kingdom, the 100,000 Genomes Project has been completed with current effort focused on making genome sequencing a routine service through the National Health Service. Dozens of other countries are leading similar initiatives and infrastructure development campaigns. Clearly, implementation of genome sequencing for use in individualized medicine initiatives are being undertaken to an extraordinary degree and may affect large segments of the global human population, including any accompanying effects that remain subtle and under-discussed within the medical community. Nevertheless, it has already been pointed out by many observers that these underemphasized subtleties in contemporary implementations of sequence-based individualized medicine are an application of eugenics.⁹ In what follows, the ramifications of individualized and personalized medicine will be examined in light of this apparent eugenicist program, with a rejoinder against the concomitant reduction of human phenotypic and genetic diversity.

In providing a critical methodological account of individualized and personalized medicine, it must first be acknowledged that the lexical semantics of “individualized”, “personalized”, and also “precision” medicine have similar yet varied meaning.¹⁰ Differences in implementation are also commonly invoked to distinguish individualized and personalized medicine. However, I will present arguments broad enough to encompass either total or partial components of the terms “individualized”, “personalized”, and “precision” in that all are concerned with a medical practice purportedly focused on the individual. This assumed focus on individual difference in treatment, as a rule, is concerned with rectifying the tendency to map probabilistic knowledge from populations to individuals (i.e. trial-and-error medicine). This is the view of individualized medicine that I will broadly take as the subject of critique. For simplicity, individualized medicine will be used hereafter. In giving a thorough exposition of individualized medicine and its processes, it will also be necessary to occasionally introduce specialist jargon. I try to limit such language to circumstances where inclusion provides enhanced contextual understanding of the problems and arguments for the reader. 

Individualized Methods?

Presenting the purported goal of individualized medicine requires an exposition of the assumptions and methods commonly used to address these goals. Arguably, the most important methodological framework for contemporary individualized medicine is genetic or genomic assessment of the individual to be treated via DNA sequencing. The application of other data collection procedures, combinatorially referred to as multi-omics, are also actively being researched and implemented in clinical applications. Most of these data collection procedures similarly utilize reductionist and gene-centric approaches in their downstream analysis and interpretation (e.g. chemical modifications of genes, metabolite production based on gene expression networks, genetic components of the human-associated microbiome, etc.). For this reason, I focus in this essay on the genetic component of individualized medicine and phenotypes with purportedly direct causal relations, as these methodologies are doing most of the conceptual and explanatory work in individualized medicine. 

These genetic methodologies can range from whole genome sequencing to various genotyping procedures for specific genes of interest. Of these procedures, the vast concern is with the identification of genetic variants (e.g. mutations in DNA known as single nucleotide polymorphisms or SNPs, differential repeat regions in DNA sequences, etc.) associated with undesirable phenotypes (e.g. memory decline, anemia, antisocial behaviors; see endnote 2). These variants, tautologically, must vary from some non-varied standard. However, the standards used for determining medically undesirable phenotypes are often based on discrete groupings of race, socioeconomic status, or ability. Factors such as high income, behavioral conformity and lack of criminality, physical abilities, etc. are often the decided norm. This is not to say there are no diseases with genetic predispositions of which we should be worried (e.g. Huntington’s Disease, beta-thalassemias) nor treatments which may be useful that individualized medicine and biotechnology more generally may provide (e.g. obvious benefits can be found in geographically targeted vaccines, treatments for the aforementioned genetic diseases, etc.). Nevertheless, the reality of these attempts at discrete groupings are often tenuous–to the dismay of oppressed peoples assigned these identities.

When these methods are applied to patients, the process used is generally as follows: “abnormal” DNA identification is first conducted through individual genome sequencing, which is then mapped onto a healthy gene or genome standard (as described above) for the identification of aberrant, deleterious, or undesirable genetic material.¹¹ Subsequent determinations of genotype-phenotype causality (in other words, how genes in an organism’s DNA determine that organism’s physical or behavioral characteristics) are then probabilistically inferred based on previous knowledge and an assumption of genotype-phenotype causal relations. Statistical methods such as genome-wide association studies (GWAS; a statistical correlation method used for determining genetic causality) are commonly used in the determination of these medically aberrant or deleterious genes or genetic markers (loci) through an associated polygenic score.¹² Polygenic scores can then be used to determine risk of disease or some other undesirable characteristic for the given individual. The utilization of this general approach is ubiquitous in individualized and personalized medicine initiatives.¹³

However, such methodologies are not without controversy, with criticism leveled against the lack of explanatory power in GWAS-based studies in individualized medicine initiatives as well as the aforementioned assumptions of genetic determinism and essentialism.¹⁴ Such controversy is especially acute as genomic-based individualized medicine initiatives intensify research on increasingly accurate and commercialized gene editing technologies as a clinical “fixing” option for individuals—either as embryos or adults.¹⁵ There is also cause to worry that current behavioral interventions and child-rearing practices are influenced by social perceptions of pre-determination when interpreting genetic test results and polygenic scores.¹⁶ GWAS-based polygenic scores in particular have been suggested as a way to personalize behavioral interventions in children that may exhibit a propensity to socially undesirable outcomes later in life. Examples of recent and contentious work includes attempts to predict criminal behavior,¹⁷ intelligence,¹⁸ income,¹⁸ and nonconformity to social norms.¹⁹ Such prognostic data is often relayed to patients or their caretakers so that interventions ranging from behavioral corrections to sexual abstinence can be put in place.²⁰ These genetic perceptions enable and concretize racial, class, and ableist groupings of the undesirable and social stigmas against them. Additionally, the propensity of patients to commit suicide for perceived altruistic reasons²¹ based on their genetic testing results has been previously demonstrated for lethal disease testing,²² and remains a serious concern even for those facing uncertain predictions of non-lethal “conditions” and their outcomes.²³

Such essentialist perspectives on genetics and individual traits rest on what is essentially teleological reasoning, with little grasp of the evolutionarily complicated and often random or nonadaptive origins of new traits.²⁴ These grouping and intervention strategies, with erroneous explanatory support, are then purportedly individualized under the guise of genome sequencing and related inferences. This move to individualization only obfuscates the social biases in such groupings and interventions further. What David King argues in his 2001 essay “Eugenic Tendencies in Modern Genetics” about such technologies and their future directionalities is seemingly being realized: “Everything will be done in the name of better health for our children, but the result, the shaping of the gene pool by social pressures and prejudices, will be no different in essence from the former eugenics.”²⁵ 

Even where phenotypic data without clear genetic underpinnings is said to be of importance, there is a frequent tendency to map these characteristics onto genetic factors. The major United States individualized medicine initiative, quixotically dubbed the “All of Us” research program, makes this point clear in their most recent vision statement:

The All of Us Research Program seeks to recruit persons in demographic categories that have been and continue to be underrepresented in biomedical research; such persons typically have relatively poor access to good health care. Race, ethnic group, age, sex, gender identity, sexual orientation, disability status, access to care, income, educational attainment, and geographic location are therefore taken into account. Because racial and ethnic identities are more than a genetic construct, we seek to capture other social and behavioral determinants of health.²⁶

While not likely ill-intentioned, this and related statements are problematic for their apparent tolerance of racial and ethnic essentialism through ambiguous and noncommittal language. This is most obvious at the point that race and ethnicity are declared as “more than a genetic construct”—as if genetics should be the necessary or foundational starting point for understanding race and ethnicity as discrete demographic categories at all. 

Frustratingly, such statements ignore the scientific challenges issued against the idea of biological race in humans, both for its basic existence and predictive potential of discrete and non-overlapping categories. These include the statement by the American Society of Human Genetics which asserted that “Genetics demonstrates that humans cannot be divided into biologically distinct subcategories.”²⁷ Such scientific challenges to race categories go back at least to the classic study by evolutionary biologist Richard Lewontin which refuted categorical genetic discreteness based on differences of inter- and intra-population genetic diversity.²⁸ In other words, his statistical analysis showed more genetic diversity within human subpopulations than between them, a finding that challenges any genetic basis for sharp delineations between human populations. A broad and accessible overview of the scientific basis of Lewontin’s work and related findings is presented by Graves and Goodman in their book Racism, Not Race: Answers to Frequently Asked Questions.²⁹ Skepticism towards the use of racial group categorization for the prediction of individual characteristics or outcomes also extends to more recent work by Kitcher.³⁰ Kitcher’s work examines philosophical notions of scientific realism and anti-realism in current debates on racial categories, thereby illuminating complexities which continue to be the subject of intense philosophical disagreements.³¹ I do not address these issues here and only highlight them so as to make clear there are aspects of biological race categories which continue to be controversial and challenged.³² More pragmatically, while there are limited instances where social categorizations of race correlate with a higher prevalence of disease, such instances are nuanced, rarely necessarily causal, and often trivial relative to other factors. 

Any sharp distinctions based on appearance (morphology) are also questionable. As Rudolf Rocker states in his magnum opus Nationalism and Culture:

To all these difficulties must be added the fact that we are not at all clear about the concept of “race,” as is seen from the arbitrary way men have played about with the classification of existing races. For a long time we were content with the four races of Linnaeus; then Blumenbach produced a fifth and Buffon a sixth; Peschel followed at once with a seventh and Agassiz with an eighth. Till at length Haeckel was talking of twelve, Morton of twenty-two, and Crawford of sixty races–a number which was to be doubled a little later… one cannot say with certainty where one race leaves off and the other begins.³³

Many large and complex analyses on the genesis of social identity can be consulted elsewhere and are not the primary focus here.³⁴ However, I will note that a distinction between anti-racism and colorblindness is also quite important, as I am in no way advocating the latter. As colorblindness aims to treat everyone as an individual, it ignores historical and persistent forms of racism that continue to shape social and health outcomes. Alternatively, anti-racism seeks to combat racism by acknowledging the experiential importance and very real implications of constructed social-identity groups and challenging the unsupported imposition of genetic normality. Any goal of a eugenically perfected human form is therefore coupled with largely fictive genetic essentialist notions of identity and genetic normality. Whether the reasons for racial classification are simply attributable to confused or apathetic views among medical practitioners, deeper ideological underpinnings, or some more complex reason is not easily discernible. However, it is not difficult to speculate that the creation and sustenance of social identity in individualized medicine is partly motivated by the desire to commodify genetic prognosis in individual health. If the ubiquity and benefits of genetic and phenotypic variability were better understood, there would likely be much less importance ascribed to genetic-essentialist notions of race and other identities in the prognostication of actual disease in individualized medicine initiatives. 

As the directions of individualized medicine are varied, some advocates of contemporary practice will argue that their methods and goals are very different from the aforementioned group-dependence, and instead intend to faithfully focus on only a single individual and use only prior data from that individual for making medical decisions. This would supposedly bypass group conformity along race, class, ability, sex, etc. lines. Such examples can be seen in the continued push for ex vivo (out of the body) medicine where parts of a patient, often in the form of cell culture, are experimented on outside of the individual under laboratory conditions. Conclusions are then drawn from these experiments for in vivo (in body) intervention.³⁵ As has been pointed out, this approach nonetheless uses previously obtained categorical group data for selecting potential treatment options. Specifically, Lammers et al. state that ex vivo experimentation and diagnoses are used to “a priori subdivide relatively large cohorts of patients into those likely to respond to a particular treatment…”³⁶ Such an approach therefore assumes and limits treatments based on information derived not from the individual but from population means and often racialized perceptions of social desirability. 

It is worth stating that some level of externally-derived knowledge is essential, with the absurdity of total medical independence argued against by reductio ad absurdum: if individualized medicine independent of external influences were to be practiced, then social factors affecting any medical decision must be eliminated. Decisions made by others, such as a physician or scientist, would also constitute such social factors. If the argument was pressed, however, a claim could be made that such a medicine would utilize strictly self-diagnosis and self-treatment following some form of egoist extremism. This would have to be committed by an individual who was totally self-taught by experiment and observation conducted only on themselves over the course of their lives. While it is possible to imagine such a rogue Robinson Crusoe adept in medical treatment through literal self-teaching and experimentation, such a medical practice would be incomprehensible in contemporary society. The argument of a purely individualized medicine with no external influences can therefore not be seriously entertained outside of abstraction. Some form of group to individual mapping must therefore be utilized when performing any form of medicine. How this can be done without using group data that has been categorized on race, class, ability, sex, etc. is nonetheless a difficult question and one which is largely unresolved in contemporary work examining this issue. If socially created identity groups are subjected to differential social treatment resulting in poorer health outcomes, and any genetic relatedness is treated as a discrete category based on these groupings, then identifying these groups for helpful medical treatment is a sort of self-fulfilling prophecy. Discrete groupings then, can be considered useful from a medical genetics perspective in that they misleadingly reinforce the previous fictions that were created. Before addressing this problem in detail, let us first examine the evolutionary implications of current approaches in individualized medicine.

Eugenics and Extinction

Current efforts to pursue programs of individualized medicine remain largely methodologically group-dependent endeavors with any purely individual medicine being in the realm of the abstract. The circular genetic-social identity influences that are intrinsic to individualized medicine inherently aim to eliminate specific genetic configurations and phenotypes that would not necessarily be harmful or lethal if left unaltered and thus transferred to the next generation. This perilous implementation of individualized medicine is therefore a form of eugenics in that it attempts to fix or eliminate undesirable genetics and supposedly linked phenotypes that social norms deem undesirable. It is more accurately a form of negative eugenics in that undesirable traits are actively eliminated (as opposed to positive eugenics which focuses on encouraging the propagation of desirable traits).³⁷ This contemporary foray into eugenics should not be rejected solely on the basis of historical comparisons to the atrocities of Nazi genocide or American sterilization programs,³⁸ although these are serious concerns. This racialized and hierarchical neo-eugenics program is also a danger to the future of our species: if allowed to proceed, its underlying circular and biased reasoning will actively deplete human genetic diversity and risk bringing us to extinction.

Historical accounts of eugenicist medical interventions were concerned with progress towards a singular and less diverse hereditary future utopia wherein humans could be ideally suited for their supposedly static environments.³⁹ But environments are not static, nor are the species which inhabit them. Biologically, it is becoming increasingly apparent that decreasing genetic diversity in a population is a predictor of species extinction with ever-changing environments.⁴⁰ As genetic and phenotypic variation for a species decreases, the extinction risk for that species increases in a correlational manner. This observed correlation has various proposed explanatory mechanisms which continue to be the subject of biological research. Indeed, phenotypic variability has been broadly shown as protective against extinction risk.⁴¹ And perhaps most importantly, genetic or phenotypic diversity and variability can amplify evolutionary novelty. The emergence of novelty may then provide more opportunities for a species to increasingly alter their environment in a manner similar to the niche construction ideas of the community ecologist Charles Elton. Broadly, Elton claimed that organisms will both shape and be shaped by the communities and environments they live in. Murray Bookchin’s often apparent affinity for Elton’s ideas can be seen in his writings on dialectical naturalism, and the relations of diversity and new evolutionary pathways of species generally (which I take to be essentially synonymous with evolutionary novelty). He argues in an essay discussing freedom and necessity in nature:

The diversity of an ecocommunity may be a source of greater stability from an agricultural standpoint; but from an evolutionary standpoint, it may be an ever-expanding, albeit nascent source of freedom within nature, a medium for providing varying degrees of choice, self-directiveness, and participation by life-forms in their own development. I wish to propose that the evolution of living beings is no mere passive process, the product of exclusively chance conjunctions between random genetic changes and “selective” environmental “forces,” and that the “origin of species” is no mere result of external influences that determine the “fitness” of a life-form to survive as a result of random factors in which life is simply an object of an indeterminable “selective” process. The increase in diversity in the biosphere opens new evolutionary pathways, indeed, alternative evolutionary directions, in which species play an active role in their own survival and change.⁴²

In humans, current genetic diversity and its quantification continue to be explored, but some interesting trends have emerged. Human genetic diversity seems to be quite low, especially when compared to that among ape species.⁴³ There is also strong evidence that the current human population passed through a severe bottleneck event in which only a small group of humans of perhaps a few thousand individuals emerged.⁴⁴ This historical group, as well as less diverse subgroups, likely faced severe inbreeding as well as extreme random genetic fluctuation (i.e. genetic drift) effects resulting in decreased population genetic diversity (i.e. linkage disequilibrium, increased homozygosity, and allelic fixation). Comparatively, small bands of chimpanzee populations exist which have more intra-genetic variation than continental human sub-populations.⁴⁵ While current work indicates a general lack of human genetic variation, humans are not chimpanzees, and much remains to be understood in the way of human genetic and related phenotypic variability. This includes the potential to acquire non-reductive forms of variation and expression such as culture and language.⁴⁶ The human population also includes specific genes associated with phenotypic variability and extinction risk which are not attributable to a lack of genome-wide variation per se.⁴⁷ It is therefore quite appropriate to maintain an agnostic yet cautious stance on total genetic and phenotypic diversity and their proclaimed causal relations in the human population. 

These insights, coupled with the still debated but at least partial role of evolutionary historical contingency,⁴⁸ provides a serious rejoinder against any methodological prescription towards the cultural, behavioral, or genetic alteration of individuals by medical interventions influenced by a categorically normative social identity. Maintenance of phenotypic and genetic diversity of a population, even of those hereditary units (genetic or cultural) indicated as aberrant, is necessary to weather and respond to unknowable long-term evolutionary and environmental change. 

This conflict between determinism and unknown potentialities has also been a focus of social ecological critique. Bookchin himself discusses this in his (admittedly polemical) critique of Richard Dawkins’ meme concept in Selfish Gene and E.O. Wilson’s genetically deterministic Sociobiology:

Dawkins’ ‘memes’, in fact, are the cultural analogues of genes, transferred from the biological to the social by means of the same naive atomism that characterizes Wilson’s ‘molecular machinery’. Like genes, memes are mimetic replicators; they duplicate cultural traits by means of imitation, just as genes duplicate biological traits by means of sexual reproduction.⁴⁹

He goes on to point out Dawkins’ apparent self-admission of the inadequacies associated with gene- or meme-centric determinism:

The Selfish Gene, which opens with an association between genetic selfishness and human selfishness, closes by producing a certain vertigo – it may be a geno-mimetic reaction – caused by Dawkin’s failure to explain where his metaphor ends and his reality begins. ‘Genes have no foresight,’ he warns us. ‘They do not plan ahead. Genes just are, some genes more so than others, and that is all there is to it.’ Genes and memes float in the air with the same stability of a kite in a hurricane. Such stirring acknowledgments of humanity’s uniqueness are rare.

This issue of indeterminacy seriously undermines any absolute programmatic attempt seeking to ameliorate individual negative health outcomes in a prognostic and fully deterministic manner. Even in the limited instances where deterministic capacities of gene-phenotype causality may be shown, the most highly desired population-level outcomes might someday become highly deleterious towards the human species. In this respect, it is worth mentioning a rather peculiar debate on the role and continued funding of SETI (Search for Extraterrestrial Intelligence) between Ernst Mayr and Carl Sagan. Mayr argued that the most likely solution to Fermi’s paradox—the failure thus far to confirm the prediction of widespread human-like intelligence in the universe—is that human intelligence as presently regarded is a lethal characteristic not amenable to long-term survival of any species in which such a phenotype arises.⁵⁰ The gloomy contention then is that intelligence, along with other characteristics considered desirable by present human societies, may quite literally be cause for species self-elimination in the future. This is broadly in agreement with recent work examining the risk of human extinction, where many socially constructed factors—all ultimately attributable to human intelligence and social complexity—are regarded as the most serious threat to species survival.⁵¹

Mayr’s thinking on this, however, may stray into blaming intelligent humanity in and of itself for our society’s social crises and omnicidal tendencies. Social ecology has indeed been sharply critical of such pessimistic Malthusian paradigms in environmental movements and academic ecology, as in Bookchin’s criticism of the ideas in Erlich’s book The Population Bomb. Specifically, the need to save humanity from some predicted species-wide catastrophe due to depletion of common resources has been a cornerstone of modern ecological thought. However, these overpopulation predictions have not fared well, and have often served racist, nationalist, and ecofascist agendas with detrimental effect. In a perhaps poetic inversion, Mayr’s argument can be flipped, as intelligence might also mean the capacity to revolutionize and create an altogether different society of social and economic relations. This new society would be one where overpopulation is not the primary cause of human suffering and environmental crises, but rather a symptom of dysfunctional socioeconomic relations and illegitimate hierarchies.

Thus, invocations of future catastrophe require careful treatment so as to not simply invert arguments for eugenics and social control in the name of species survival. Where historical eugenic programs sought to alter or eliminate individuals for the goal of a singular and categorical race, class, ability, sex, etc. so could exist an equally tyrannical goal of maintaining or increasing population diversity at all costs. Perhaps it would not be so far-fetched to imagine an alternative (or inverted) eugenics where top-down and reductionist social controls are used for the implementation of miscegenistic forms of planned human breeding as a “genetic diversity” initiative. Such proposals to “improve” the human species have been proposed historically but were not subject to widespread implementation.⁵² Though not implemented with humans, such proposals would not be so different in practice from what many zoos and wildlife conservationists already do when attempting to revive near extinct species for their future “survival” in the wild. Interestingly, it seems that this theoretical form of eugenics has never taken hold in the modern medical realm—though it flourishes in the “white genocide” fantasies and reactionary tropes of white nationalists, such as in Ward Kendall’s Hold Back This Day. This also aligns with ecofascist calls for racialized and ethnic “diversity” initiatives to culturally and genetically wall off white nationalities under the auspices of ethno-pluralism.⁵³ The terrifying possibility of genome sequencing and genetic editing tools of individualized medicine initiatives being deployed towards the ends of white racial separatism and improvement should therefore be considered a very real future possibility. Especially as planned miscegenation and ethno-pluralism may align with existing fringe-liberal and far-right politics, respectively. This potential for an ideological tug-of-war and related feedback loop should be viewed as quite dangerous if ever infused with mainstream identity politics.

The increased risk of our self-imposed extinction therefore casts an ominous shadow over any reorienting of individualized medicine’s eugenic tendencies. Societies where undesirable genes and phenotypes correlating with undesirable social predispositions are deliberately eliminated from the human population under the auspices of individualized medicine may do so to the detriment of those racialized or disabled by our present oppressive social order, and at great risk to the future survival of humanity. Plainly, there is no way to assume what may be useful in the future or may provide the human lineage with social benefits which we cannot yet imagine. 

Though an outright abandonment of individualized medicine would be an understandable reaction to these concerns, there are still positive potential applications of its ever-increasing technological toolbox, by way of a third approach. Medical practitioners should instead embrace a social ecological framework that prioritizes bottom-up diversity, evolutionary self-direction, tolerance, and spontaneity  as a way out of this apparent dilemma. Social ecology may therefore have much to contribute as an important and liberatory advance in a medical world where reductive genetic tendencies are becoming increasingly entrenched under the auspices of individualized medicine and their associated commodification regimes. It is therefore argued that a social ecological conceptualization is a benefit for both individuals and populations vis-à-vis the biological idea of species survival.

A Social Ecology and Individualized Medicine Rapprochement

Social ecology provides a robust and actionable basis by which to address the many illegitimate social relations and hierarchies of our time. While I am not here aiming for a comprehensive strategy towards building dual-power in the powerful medical-industrial complex (although I am certainly open to this), I do aim to bring a recognition of the potential anti-eugenic perspective social ecology could provide. In rejecting any purely individual medicine on account of its impossibility, its reification of  oppressive social group categories (e.g. race, class, ability, sex, etc.), and its species-suicidal implications, at least one account for a rational implementation of quasi-individualized medicine seems plausible. Namely, as increasing genetic variation and phenotypic diversity generally correlate inversely with extinction risk, utilization of prior data in a new paradigm where genetic and phenotypic diversity is maintained and respected as a feature of a shared humanity may serve us well. Such a human-oriented and group-transcendent implementation of medicine would allow a path where individuals may experience a liberatory and non-coercive form of medicine not obscured by group identity, genetic commodification, and state-sanctioned hierarchical exploitation. Here, we may invoke the social ecology paradigm of dialectical naturalism as an advocatory embrace of a shared humanity through variety. Indeed, Bookchin himself writes of a need to set aside race and nationality for the emancipatory potentialities of humanity to be fully realized.⁵⁴ Such a program should be reconcilable with a view towards spontaneity. Navigating these is a most apt strategy, as Elton and Bookchin seem to agree:

Thus a considerable amount of leeway must be permitted for natural spontaneity–for the diverse biological forces that yield a variegated ecological situation. “Working with nature” requires that we foster the biotic variety that emerges from a spontaneous development of natural phenomena. I hardly mean that we must surrender ourselves to a mythical “Nature” that is beyond all human comprehension and intervention, a Nature that demands human awe and subservience. Perhaps the most obvious conclusion we can draw from these ecological tenets is Charles Elton’s sensitive observation: “The world’s future has to be managed, but this management would not be just like a game of chess–[but] perhaps more like steering a boat.” What ecology, both natural and social, can hope to teach us is the way to find the current and understand the direction of the stream.⁵⁵

Such a strategy also has ramifications on individual freedoms, as respect for individual freedoms is maintained and in general accordance with the population goal of avoiding aspirations of genetic and phenotypic uniformism. Population genetic diversity is viewed as a resource and not a restriction, wherein individuals and society are not at odds. Corresponding with these notions of freedom is an inseparable sense of justice for all people. Any medical practice rooted in irrational forms of group identity and eugenics cannot make this claim, as individual freedoms and corresponding forms of justice are necessarily violated for immediate perceptions of normality towards some preferred and identity group. This alternative approach should therefore be considered a distinct paradigm for the operation of medical genetic approaches and individualized medicine in particular. This is in stark contrast to the current and rapidly expanding paradigm for individualized medicine which naively promotes a decrease in human genetic and phenotypic diversity which, as previously shown, is harmful from both the perspective of individual freedoms and also species survival.

In summary, individualized medicine purports to enhance individual health and survival in a group-independent manner. Nevertheless, methods for the biased alteration of current and future human populations using genomic coercion and augmentation of human behaviors for desired phenotypes results in individual enhancement that is necessarily dependent on identity and often racialized group assumptions. Such normative assumptions can intertwine with medical practice to alter population genetic structure and phenotypic diversity towards a monolithic humanity. Implementation of such enhancement comes with the nontrivial risk of decreasing genetic and phenotypic variation in populations, thereby increasing extinction risk. If categorization by group identity, exploitation, and associated extinction risk are concerns, then current implementations of individualized medicine as both a state-sponsored initiative and increasingly standardized medical practice requires profound changes. The upshot is that such changes could be guided through a critical yet informed social ecological framework. Yet it remains to be seen if the core tenets of social ecology will ever replace current implementation schemes rooted in rigid hierarchy and identity assignments. It would seem such changes are necessary for a preemptive evidence-based medicine that avoids essentialist and deterministic notions of identity, increased threat of human extinction, and counter-revolutionary structures of social control.

1. Genetic here refers to an individual’s nucleic acids, most notably DNA, which is heritable from one generation to the next. Genotype is also occasionally used and refers to the genetic material specific to an individual. Where gene is used, I refer to what is generally regarded as the basic unit of functional DNA; canonically coding for a single protein. Where genomic is used, I am referring to the entire set of DNA based instructions in an individual.
2. Throughout this paper the word phenotype is also used. Phenotype and phenotypic as used here are broadly encompassing terms for individual characteristics that have both a non-genetic and/or genetic basis. These characteristics may be determined by genetic material, but not necessarily so. Additionally, these characteristics may contain but are not limited to physical morphology, appearance, and behavior. Generally speaking, these forms may be partially heritable. Where heritability exists, it should also not be assumed that such heritability of these characteristics is exclusively genetic. Throughout the paper, I treat genotype and phenotype separately for purposes of convenience and brevity. Although the relations between genetic and phenotypic variation are complex and certainly interconnected, debates continue as to how one may capitulate into the other in dual-inheritance theory, and relatedly the Baldwin effect (see Simpson 110–17), genetic assimilation (Waddington 118–26), and epiphenomenal explanations of behavior and language (see Hauser et al. 1569–79). Where certain tensions seem to exist, it is likely due to this simplification.
3. Konstantinos N. Lazaridis, et al, “Implementing individualized medicine into the medical practice”, American Journal of Medical Genetics Part C: Seminars in Medical Genetics (Vol. 166, No. 1, 2014).
4. Francis Galton, “Eugenics: Its definition, scope, and aims”, American Journal of Sociology (Vol. 10, No. 1, 1904), 1–25.
5. A. Dirk Moses and Dan Stone, “Eugenics and genocide,” The Oxford Handbook of the History of Eugenics (2010), 192.
6. A term used by Li et al. to point out this common phenomena in medical education literature. See: A. Li, A.T. Deyrup, J.L. Graves Jr, & L.F. Ross, “Race in the Reading: A study of problematic uses of race and ethnicity in a prominent pediatrics textbook”, Academic Medicine: Journal of the Association of American Medical Colleges (Vol. 97, No. 10, September 2022), 1521-1527.
7. Sequencing is a commonly used methodology for deciphering the DNA “code” from an individual’s genetic material. The Human Genome Project was the first complete example of this, costing billions of dollars. Current costs have dropped to only thousands of dollars for one individual, making the technology accessible, affordable, and scalable for applications in medicine.
8. Paul Nicolaus, “National Genomic Data Initiatives: A Worldwide Update,” Bio IT World, Cambridge Healthtech Institute (2019). www.bio-itworld.com/2019/08/12/national-genomic-data-initiatives-worldwide-update.aspx.
9. Robert Pollack, “Eugenics lurk in the shadow of CRISPR”, Science (348.6237, 2015), 871.
10. Sui Huang and Leroy Hood, “Personalized, Precision, and N-of-One Medicine: A Clarification of Terminology and Concepts”, Perspectives in biology and medicine (Vol. 62, No. 4, 2019), 617–639; Eric Juengst, et al., “From ‘personalized’ to ‘precision’ medicine: the ethical and social implications of rhetorical reform in genomic medicine”, Hastings Center Report (Vol. 46, No. 5, 2016), 21–33.
11. Lora JH Bean and Madhuri R. Hegde, “Gene variant databases and sharing: creating a global genomic variant database for personalized medicine”, Human Mutation (Vol. 37, No. 6, 2016), 559–563.
12. Genome-wide association studies are a genome-based method for correlating specific genes with various phenotypes. Such methods use a number of statistical techniques to create probabilistic polygenic scores. Polygenic scores are used for quantifying gene-phenotype correlations that are often presented as causal.
13. Konstantinos N. Lazaridis, et al, “Outcome of whole exome sequencing for diagnostic odyssey cases of an individualized medicine clinic: the Mayo Clinic experience”, Mayo Clinic Proceedings (Vol. 91, No. 3, 2016); Jill M. Pulley, et al, “Operational implementation of prospective genotyping for personalized medicine: the design of the Vanderbilt PREDICT project”, Clinical Pharmacology & Therapeutics (Vol. 92, No. 1, 2012), 87–95.
14. Noah A. Rosenberg, et al, “Interpreting polygenic scores, polygenic adaptation, and human phenotypic differences”, Evolution, medicine, and public health (2019.1, 2019), 26–34.
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23. Robin E. Grubs, Lisa S. Parker, and Rebekah Hamilton, “Subtle psychosocial sequelae of genetic test results”, Current Genetic Medicine Reports (Vol. 2, No. 4, 2014), 242–49.
24. Stephen Jay Gould and Richard C. Lewontin, “The spandrels of San Marco and the Panglossian paradigm: a critique of the adaptationist programme”, Proceedings of the royal society of London. Series B. Biological Sciences (205.1161, 1979), 581–98.
25. David King, ‘Eugenic Tendencies in Modern Genetics’, Redesigning life?: the worldwide challenge to genetic engineering, edited by Brian Tokar (London and New York, Zed Books, 2001), 171–81.
26.  All of Us Research Program Investigators, “The ‘All of Us’ research program”, New England Journal of Medicine (Vol. 381, No. 7, 2019), 668–76.
27. American Society of Human Genetics. (2018). ASHG denounces attempts to link genetics and racial supremacy. Am J Hum Genet, 103, 636.
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29. Joseph L. Graves and Alan H. Goodman, “Everything You Wanted to Know about Genetics and Race”, chapter 2 in Racism, Not Race: Answers to Frequently Asked Questions (New York, Columbia University Press, 2021), 42-58.
30.  Philip Kitcher, “Does’ race’ have a future?”, Philosophy and Public Affairs (2007), 293–317.
31. Bas C. Van Fraassen, The scientific image (Oxford, Oxford University Press, 1980).
32.  Interestingly, anti-realist notions such as constructive empiricism seem to share certain conceptual similarities with the Hegelian Idealism found in social ecology (likely due to Josef Weber’s influence on Murray Bookchin). There is normally little crosstalk here due to the historical split between “continental” and “analytic” philosophy following the work of Gottlob Frege, effectively leaving two sub-currents in Western philosophy (i.e. the linguistic turn). It is conceivable that this gap could be bridged in social ecology, and very seriously expand theoretical and normative insights beyond the constraints of any one sub-discipline.
33.  Rudolf Rocker, Nationalism and Culture, trans. Ray E. Chase(Stillwatter, Minnesota, Croixside Press, 1978 Edition reprint), 299.
34.  Stephan Fuchs, Against Essentialism: A Theory of Culture and Society. (Cambridge, MA, Harvard University Press, 2009);  David Graeber and David Wengrow, The Dawn of Everything: A New History of Humanity (New York, Farrar, Straus and Giroux, 2021).
35. Arjanneke F. van de Merbel, et al, “An ex vivo tissue culture model for the assessment of individualized drug responses in prostate and bladder cancer”, Frontiers in oncology (Vol. 8, 2018), 400.
36. Twan Lammers, et al, “Personalized nanomedicine”, Clinical Cancer Research (Vol. 18, No. 18, 2012), 4889–94.
37.  Bertrand Russell, “Eugenics”, in Marriage and Morals (Allen and Unwin, 1929), 203.
38. André N. Sofair and Lauris C. Kaldjian, “Eugenic sterilization and a qualified Nazi analogy: the United States and Germany, 1930-1945”, Annals of Internal Medicine (Vol. 132, No. 4, 2000), 312–319.
39.  Francis Galton, “Hereditary Improvement”, Fraser’s magazine (Vol. 7, No. 37, 1873), 116–130.
40. Morten E. Allentoft and John O’Brien, “Global amphibian declines, loss of genetic diversity and fitness: a review”, Diversity (Vol. 2, No. 1, 2010), 47–71; Richard Frankham, “Genetics and extinction”, Biological conservation (Vol. 126, No. 2, 2005), 131–140; Robert C. Lacy, “Importance of genetic variation to the viability of mammalian populations”, Journal of Mammalogy (Vol. 78, No. 2, 1997), 320–35; Derek Spielman, Barry W. Brook, and Richard Frankham, “Most species are not driven to extinction before genetic factors impact them,” Proceedings of the National Academy of Sciences (Vol. 101, No. 42, 2004), 15261–64.
41. Simon Ducatez, et al, “Colour polymorphism is associated with lower extinction risk in birds”, Global change biology (Vol. 23, No. 8, 2017), 3030–39; Tasmin L. Rymer, Neville Pillay, and Carsten Schradin, “Extinction or survival? Behavioral flexibility in response to environmental change in the African striped mouse Rhabdomys“, Sustainability (Vol. 5, No. 1, 2013), 163–86.
42. Murray Bookchin, “What Is Social Ecology?” (1984), in The Murray Bookchin Reader, ed. Janet Biehl (Montreal, Black Rose Books, 1999), 43–44.
43. Javier Prado-Martinez, et al, “Great ape genetic diversity and population history,” Nature (499.7459, 2013), 471–75.
44. Luke S. Premo and Jean-Jacques Hublin, “Culture, population structure, and low genetic diversity in Pleistocene hominins”, Proceedings of the National Academy of Sciences (Vol. 106, No. 1, 2009), 33–37; Stanley H. Ambrose, “Late Pleistocene human population bottlenecks, volcanic winter, and differentiation of modern humans”, Journal of human evolution (Vol. 34, No. 6, 1998), 623–51.
45. Rory Bowden, et al, “Genomic tools for evolution and conservation in the chimpanzee: Pan troglodytes ellioti is a genetically distinct population”, PLoS Genetics (Vol. 8, No. 3, 2012), e1002504.
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48. Zachary D. Blount, Richard E. Lenski, and Jonathan B. Losos, “Contingency and determinism in evolution: Replaying life’s tape,” Science (362.6415, 2018); Stephen Jay Gould, The structure of evolutionary theory (Cambridge, MA, Harvard University Press, 2002).
49. Murray Bookchin, Re-enchanting Humanity, (London, Cassell,1995), 41–2.
50. Carl Sagan and Ernst Mayr, “Debate About the Probability of Intelligent Life in the Universe”, Bioastronomy News (Vol. 7, No. 4, 1995).
51. Andrew E.  Snyder-Beattie, Toby Ord, and Michael B. Bonsall, “An upper bound for the background rate of human extinction”, Scientific reports (Vol. 9, No. 1, 2019), 1–9.
52. A Treatise on the Patriarchal, Or Co-operative, System of Society as it Exists in Some Governments, and Colonies in America: And in the United States, Under the Name of Slavery, with Its Necessity and Advantages
53. Blair Taylor, “Alt-right ecology: Ecofascism and far-right environmentalism in the United States”, The Far Right and the Environment (Routledge, 2019), 275–292 (279–81).
54. Murray Bookchin, The Next Revolution: Popular Assemblies and the Promise of Direct Democracy (London and New York, Verso Books, 2015), 111–16. See also Blair Taylor’s piece in this issue, “Social Ecology, Racism, Colonialism, and Identity: Assessing the Work of Murray Bookchin”. https://harbinger-journal.com/issue-2/social-ecology-racism-colonialism-and-identity-assessing-the-work-of-murray-bookchin/.
55. Murray Bookchin, The Ecology of Freedom (Oakland, AK Press, 2005), 89–90.